Meta-analysis of initial seizure thresholds in electroconvulsive therapy

Waarde, Jeroen A. van; Verwey, Bastiaan; Mast, Rose C. van der

doi:10.1007/s00406-009-0011-7

Cited by 37 publications

(23 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results, however, cannot be directly compared because of differences in ECT device and titration schedule. A recent meta‐analysis including various races and areas concluded that ST had a wide distribution and the mean ST was 111.6 mC . The Consortium for Research in ECT (CORE) study with a large sample size reported a mean ST of 127 mC, which is close to the present result.…”

Section: Discussionsupporting

confidence: 85%

“…Clearly, the relationship between history of ECT and alterations of ST needs further elucidation. Although BMI, antipsychotics, antidepressants, anticonvulsants, and lithium have been identified as potential factors, these were not found to have a significant influence on ST in the present study. Only 11% of the present subjects were prescribed certain anticonvulsants, meaning that they might have had a less significant influence on ST compared to benzodiazepine medication.…”

Section: Discussioncontrasting

confidence: 75%

See 1 more Smart Citation

Seizure threshold and the half‐age method in bilateral electroconvulsive therapy inJapanese patients

Yasuda

Kobayashi

Yamaguchi

et al. 2014

Psychiatry Clin Neurosci

View full text Add to dashboard Cite

Aim: Seizure threshold (ST) in electroconvulsive therapy (ECT) has not been reported previously in Japanese patients. We investigated ST in bilateral ECT in Japanese patients using the dose-titration method. The associations between demographic and clinical characteristics and ST were analyzed to identify the predictors of ST. Finally, the validity of the half-age method for the stimulus dose was evaluated.Methods: Fifty-four Japanese patients with mood disorder, schizophrenia, and other psychotic disorders received an acute course of bilateral ECT using a brief-pulse device. ST was determined at the first session using a fixed titration schedule. ST was correlated with age, sex, body mass index, history of previous ECT, and psychotropic drugs on multiple regression analysis. Furthermore, the rate of accomplished seizures was calculated using the half-age method.Results: Mean ST was 136 mC. ST was influenced by age, sex, history of previous ECT, and medication with benzodiazepines. The accomplished seizure rate using the half-age method was 72%, which was significantly lower in men and subjects on benzodiazepines. Conclusion:ST in Japanese patients was equal to or slightly higher than that previously reported in other ethnic groups, which might be attributable, at least in part, to high prevalence of and large-dose benzodiazepine prescription. Higher age, male gender, no history of ECT, and benzodiazepines were related to higher ST. The half-age method was especially useful in female patients and subjects without benzodiazepine medication.

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Discussioncontrasting

confidence: 75%

Seizure threshold and the half‐age method in bilateral electroconvulsive therapy inJapanese patients

Yasuda

Kobayashi

Yamaguchi

et al. 2014

Psychiatry Clin Neurosci

View full text Add to dashboard Cite

show abstract

“…The initial ST (IST) has been defined as the smallest electrical dose needed to produce a generalized seizure of at least 25–30 s on an electroencephalogram (EEG) at the first session [1, 8]. IST is reported to vary substantially between patients [2], although prospective studies are sparse [4, 32]. …”

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

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…Stimulus dose, age, sex, treatment number, and psychotropic medication affect seizure duration. Age and treatment number are inversely correlated with seizure duration, and seizure threshold is higher in men relative to women 6–9. Each psychotropic medication has an effect on seizure threshold by increasing or decreasing it, and anesthetics for sedating patients during ECT also influence this threshold 10–14…”

Section: Introductionmentioning

confidence: 99%

Effects of stimulus parameters on motor seizure duration in electroconvulsive therapy

Joo¹,

Joo²,

Kim³

et al. 2017

NDT

View full text Add to dashboard Cite

ObjectiveThis study examined the effect of stimulus parameters on the occurrence of adequate seizures and reconsidered the factors related to motor seizure duration.MethodsThe medical records of 187 patients who received ECT in Asan Medical Center from January 2007 to May 2014 were retrospectively reviewed. The starting stimulus dose was determined using a preselected-dose method and the cutoff value to determine the adequate motor seizure duration was 20–25 seconds. The association between seizure parameters and the occurrence of adequate seizure was assessed with logistic regression using a generalized estimating equation.ResultsAge (P<0.001), use of mood stabilizers (P=0.002), and benzodiazepine (P<0.001) were significantly lower in sessions with an adequate seizure duration but use of antidepressants (P<0.001) and clozapine (P=0.025) were significantly higher in sessions with an adequate seizure duration. In the generalized estimating equation analyses, after adjustment for age, benzodiazepine dose, and lamotrigine use, charge (odds ratio [OR] =0.999; 95% confidence interval [CI], 0.998–1.000; P=0.005), and train duration (OR =0.632; 95% CI, 0.490–0.817; P<0.001) were significantly associated with the occurrence of adequate seizure.DiscussionStimulus charge and train duration are significantly associated with motor seizure duration. However, train duration appears to have a greater effect on motor seizure duration. Additionally, age, benzodiazepine dose, and lamotrigine use independently affect motor seizure duration.

show abstract

Meta-analysis of initial seizure thresholds in electroconvulsive therapy

Cited by 37 publications

References 54 publications

Seizure threshold and the half‐age method in bilateral electroconvulsive therapy inJapanese patients

Seizure threshold and the half‐age method in bilateral electroconvulsive therapy inJapanese patients

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

Effects of stimulus parameters on motor seizure duration in electroconvulsive therapy

Contact Info

Product

Resources

About