Convulsive threshold differences in right unilateral and bilateral ECT

McCall, W. Vaughn; Shelp, Frank; Weiner, Richard D.; Austin, Shirley; Norris, Judy

doi:10.1016/0006-3223(93)90152-4

Cited by 46 publications

(14 citation statements)

References 15 publications

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“…In accordance with other studies [4, 9, 10, 14, 15, 18, 21, 23], we also found that BL electrode placement predicted higher ST levels during the ECT course and more often showed a rise in ST compared with RUL-treated patients. The higher ST in case of BL electrode placement might be related to differences in current pathways; that is, in BL ECT, there is a greater interelectrode distance than in RUL ECT, probably resulting in more shunting of current through the scalp which might require a higher electrical dosage to elicit seizure activity [25].…”

Section: Discussionsupporting

confidence: 92%

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Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study

Waarde

Oudheusden

Verwey

et al. 2012

Eur Arch Psychiatry Clin Neurosci

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At the start and during the course of electroconvulsive therapy (ECT), estimation of the seizure threshold (ST) is useful in weighing the expected effectiveness against the risks of side effects. Therefore, this study explores clinical factors predicting initial ST (IST) and levels of ST during the ECT course. This prospective observational study included patients aged ≥18 years receiving ECT without contraindications for dose titration. At the first and every sixth consecutive ECT session, ST level was measured. Using multivariate linear regression and multilevel models, predictors for IST and change in ST levels were examined. A total of 91 patients (mean age, 59.1 ± 15.0 years; 37 % male; 97 % diagnosis of depression) were included. In multivariable analysis, higher age (β = 0.24; P = 0.03) and bifrontotemporal (BL) electrode placement (β = 0.42; P < 0.001) were independent predictors for higher IST, explaining 49 % of its variation. Also, these two variables independently predicted higher ST levels at different time points during the course. Using multilevel models, absence of a previous ECT course(s) predicted a steeper rise in ST during the course (P = 0.03 for the interaction term time*previous ECT). The age-adjusted dose-titration method is somewhat crude, resulting in some measurement error. Concomitant medication use could have influenced ST levels. Increasing age and BL electrode placement predicted higher (I)ST, which should be taken into account when selecting ECT dosage. Previous ECT course(s) may avoid an increase in ST during the course of ECT.

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Section: Discussionsupporting

confidence: 92%

“…Higher IST is associated with male gender [4, 21], advanced age [4, 21, 24], bifrontotemporal (BL) electrode placement [4, 10, 18], lower dynamic impedance [10, 23], a greater burden of medical illness [4], higher body mass index (BMI) [4, 7], and previous ECT course(s) and concomitant medication use [1, 4]. …”

Section: Introductionmentioning

confidence: 99%

Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study

Waarde

Oudheusden

Verwey

et al. 2012

Eur Arch Psychiatry Clin Neurosci

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“…The obtained threshold is influenced by technical parameters of the challenge and individual differences factors. ST is markedly higher with BL than RUL ECT (Sackeim et al, 1987a, b;McCall et al, 1993), with sine wave than brief pulse stimulation (Weiner, 1980), and with brief pulse than ultra-brief pulse stimulation. There are also marked individual differences in ST, which increases with age and is higher in men than women (Sackeim et al, 1987b;Coffey et al, 1995;Colenda and McCall, 1996;Lisanby et al, 1996;Boylan et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Seizure Expression During Electroconvulsive Therapy: Relationships with Clinical Outcome and Cognitive Side Effects

Perera

Luber

Nobler

et al. 2004

Neuropsychopharmacol

129

102

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Since electroconvulsive therapy (ECT) can result in generalized seizures that lack efficacy, physiological markers of treatment adequacy are needed. Specific electroencephalographic (EEG) features differentiate seizures produced with barely suprathreshold right unilateral (RUL) ECT, an ineffective treatment, from effective forms of ECT. This study determined whether EEG features are sensitive to treatment condition using a broad dosing range for RUL ECT, as well as predictive of clinical and cognitive outcomes. Quantitative EEG measures and observer ratings were compared in predictive power. From a larger study, 54 in-patients with major depression were randomized to low (1.5 Â seizure threshold (ST)), moderate (2.5 Â ST), or high-dose (6 Â ST) RUL ECT, or high-dose (2.5 Â ST) bilateral (BL) ECT. High dosage RUL and BL ECT were comparable in efficacy, and superior to low and moderate dosage RUL ECT. In the slow frequency bands (d), BL ECT resulted in greater ictal power, ictal coherence, and postictal suppression than each RUL ECT condition, but the EEG measures failed to discriminate the RUL ECT groups. EEG measures were modestly associated with clinical outcome, with greater ictal power, d coherence, and postictal suppression positive predictors. None of the EEG measures were associated with cognitive outcomes. Inability to distinguish forms of RUL ECT differing markedly in dosage and efficacy suggests that EEG measures have limited potential as markers of treatment adequacy. Rather than assaying treatment adequacy, the EEG features associated with efficacy may reflect individual differences in the strength of inhibitory processes that terminate the seizure, and can help isolate the biological variability that predisposes to positive or negative clinical response to ECT.

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“…Anthropometric research regarding the forehead width showed a decrease of the bony and skin surface in old women (aged 81-90 years) but not in men, compared to youngsters [46]. As a consequence interelectrode distance as well as the skin-electrode interface may be relatively smaller in elderly women and thus contribute to lower seizure thresholds compared to elderly men [17]. This is, however, not consistent with the fact that reduced interelectrode distances have been associated with Table 2…”

Section: Morphological Factors and Decreased Neuroexcitabilitymentioning

confidence: 85%

“…The mean age of these samples ranged from 43.6 to 67.1 years and the absolute age from 18 to 93 years ( Table 1). In all studies moderate significant overall correlations (r=0.30-0.64, p<0.05) between initial seizure thresholds and age were found [9,10,[15][16][17][18][19][20][21][22][23][24][25], except for one unilaterally treated female sample (r=0.098; p>0.05) [22], a bilaterally treated male sample (r=-0.47, p=0.17) [22] and a bilaterally treated female sample (r=-0.06; p>0.05) [23]. After Ztransformation, sample size weighted average correlation coefficients were 0.42 ± 0.12 in right unilateral treated samples, 0.48 ± 0.07 in bilateral treated samples and 0.37 ± 0.06 in samples treated with both electrode placements, which are moderate correlations.…”

Section: Initial Seizure Threshold In Relation To Agementioning

confidence: 98%

Seizure Thresholds in Elderly Patients Treated with Electroconvulsive Therapy for Major Depressive Disorder: A Review

Waarde¹,

Rose²

2010

CPSR

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Objective: Electroconvulsive therapy (ECT) is effective and generally safe in depression. Its effectiveness and side effects are suggested to be related to the electrical stimulus administered relative to the seizure threshold. Since aging seems to raise the seizure threshold in ECT, we reviewed the literature for evidence correlating advanced age and seizure threshold, and for hypotheses explaining why seizure thresholds might raise with age.Methods: Pubmed, PsychINFO, three standard works on ECT, and cross-references were searched for studies investigating seizure thresholds and/or associated factors in elderly depressed patients.Results: A total of 406 possibly relevant articles were found, of which 27 studies could be included. One very recently published study was included afterwards because of its significance. Aging was moderately associated with a raised initial seizure threshold with correlation coefficients ranging from 0.30 to 0.64 (p<0.05). Also, seizure thresholds in elderly patients were more likely to raise during the ECT course. Reported hypotheses for these clinical phenomena include a decrease of neuroexcitability, changes in morphologic and functional characteristics of the brain, somatic comorbidity, and concomitant medication use.Conclusion: To optimize ECT in elderly patients, hypotheses and suggestions for further research are proposed regarding the moderate correlation between advanced age and initial seizure threshold and the rise in seizure threshold during the ECT course.

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Convulsive threshold differences in right unilateral and bilateral ECT

Cited by 46 publications

References 15 publications

Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study

Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study

Seizure Expression During Electroconvulsive Therapy: Relationships with Clinical Outcome and Cognitive Side Effects

Seizure Thresholds in Elderly Patients Treated with Electroconvulsive Therapy for Major Depressive Disorder: A Review

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