Intravenous theophylline is the most effective intervention to prolong EEG seizure duration in patients undergoing electroconvulsive therapy

Abstract

BackgroundSeizure duration in electroconvulsive therapy (ECT) is positively related with patients’ outcome. This study sought to investigate the impact of anesthetic management on seizure duration, and the impact of selected drugs (theophylline, remifentanil, S-ketamine) on seizure duration.MethodsRetrospective analysis of all patients undergoing ECT at our institution from January 2011 to April 2012 was performed based on electronic medical chart and review of existing quality improvement data. Patient data (N = 78), including gender, age, height, weight, and administered drugs, energy levels, and electroencephalic seizure duration were analyzed. Statistical analysis was performed using a generalized linear model.ResultsA total of 78 patients (male = 39, female = 39, age 51 ± 12 years) were included. Average number of session was 10 ± 6 (1–30). In our patient population, theophylline administration was the only parameter, which significantly prolonged seizure duration, whereas S-ketamine, remifentanil, thiopental, age, sex, session or energy level had no significant effect.ConclusionTheophylline can be a useful adjunct for patients with inadequate seizure duration. If there is a concomitant beneficial effect on patients’ outcome needs to be investigated in further studies.

Subanesthetic dose of ketamine for the antidepressant effects and the associated cognitive impairments of electroconvulsive therapy in elderly patients—A randomized, double‐blind, controlled clinical study

“…Similarly to most commonly used intravenous anesthetics, propofol has no significant effect on the efficacy of ECT (Bauer et al., 2009). In order to improve this efficacy, several studies have tried to improve various parameters of electric shock treatment in recent years, including the course of treatment, electrical dose, adjunctive anesthesia drugs, and so on (Li et al., 2017; Tzabazis et al., 2017). Ketamine was first used in the clinic as an anesthetic, and many preclinical and clinical studies have shown that it has rapid antidepressant effects(Correia‐Melo, Argolo, Araújo‐de‐Freitas, Leal, & Kapczinski, 2017; Koike, Iijima, & Chaki, 2011; Wilkinson et al., 2018), which last for a long time, even more than one week.…”

Tardive Seizures After Electroconvulsive Therapy

“…58,59 Certain medications such as theophylline (1 case), bupropion (2 cases), and β-lactam antibiotics (2 cases) have well-described seizure threshold-lowering effects. 60,61 Outside of ECT, seizures have been reported during therapeutic use of most antidepressants and antipsychotics, with ECT studies demonstrating a trend toward longer seizure length. 57,62,63 This is often a dose-and speed of titration-dependent effect.…”

Effects of Caffeine, Theophylline, and Aminophylline on Electroconvulsive Therapy

“…Some studies suggest that theophylline administration is associated with improvement in seizure duration when given to patients receiving ECT. [ 10 14 ] An open-label study was conducted on eight patients receiving ECT, in which oral sustained-release theophylline (200 mg–400 mg) was given 10 h prior to ECT treatment. Theophylline level was on average 3.4 ± 0.7 mg/L after 200 mg, except one patient who had a level of 6.2 mg/L after a 400 mg dose.…”

“…performed a retrospective chart review on 78 patients undergoing ECT, with an average number of 10 ± 6 sessions. [ 10 ] These patients received multiple medications prior to or during ECT treatment sessions. The most commonly used medications were etomidate, theophylline, remifentanil, and S-ketamine.…”