Seizure duration and clinical effect in electroconvulsive therapy

Maletzky, Barry M.

doi:10.1016/0010-440x(78)90086-x

Cited by 136 publications

(39 citation statements)

References 16 publications

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“…Although there is no beneficial effect with only one seizure, clinical improvement can be observed with a total seizure time over 210 seconds (7) . Because the seizure is the therapeutic agent, the duration of seizure discharge is the significant variable of therapeutic efficacy.…”

Section: Seizure Durationmentioning

confidence: 99%

“…Use of general anaesthesia led to the reduced incidence of physical and psychological trauma. Since the 1960s, ECT under general anesthesia with quick-acting barbiturates has been used for the treatment of depression.The ideal intravenous anesthetic agents used for modified electroconvulsive therapy (MECT) should provide:rapid onset of action (6), short duration of action (5), attenuation of the adverse physiological effects of ECT,rapid post-ictal recovery of consciousness (5) and should not adversely shorten seizure time because of the probable beneficial relationship between total seizure and treatment efficacy (7) . Due to non-availability of methohexitone, thiopentone sodium was being used till date for all MECTs despite of its side effects like prolonged awakening time, arrhythmias, laryngeal spasm and the hang over associated with its use is a definite disadvantage specially in psychiatric outpatient department where patients have to go back to their homes soon after the treatment.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the haemodynamic effects and seizure activity during modified ECT with thiopentone and propofol used as inducing agents.

Premendran¹

2012

iosrphr

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Abstract:--Electroconvulsive therapy is also known as Electroshock or Shock therapy or Electroplex.Seizure activity produced by ECT is considered as the therapeutic aspect of this form of treatment, but is accompanied by untoward physiologic consequences, mainly cardiovascular and cerebral in nature. The hemodynamic effects can have a significant impact in patients with underlying cardiovascular disease.The effects of certain anesthetic agents may render seizure activity difficult to generate,and the unmodified physiologic consequences of treatment may be harmful. At the present time, a number of medications have been used during ECT including pretreatment sedation, anaesthetic agents, muscle relaxants, anticholinergics, and drugs to attenuate parasympathetic and sympathetic responses. This single blinded study was carried out on 100 adult patients equally divided into two groups of 50 each to compare the Hemodynamic effects and seizure activity of thiopentone sodium (GroupT) and propofol(Group P) when used as inducing agents in patients undergoing modified electroconvulsive therapy (MECT). Results showed propofol maintained significantly better haemodynamics compared to thiopentone and seizure time was significantly lower with propofol compared to thiopentone with equal theurapeutic effect and comparable complication rate of MECT. Recovery from anaesthesia post MECT was significantly quicker with propofol compared with thiopentone. Hence,we conclude that from anaesthesiologist's point of view propofol has advantage over thiopentone when used as an induction agent for modified ECT due to its favorable haemodynamics and early recovery characteristics.

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Section: Seizure Durationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the haemodynamic effects and seizure activity during modified ECT with thiopentone and propofol used as inducing agents.

Premendran¹

2012

iosrphr

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“…Studies examining the potential effects of anaesthetic agents on the therapeutic effect of ECT often assume that duration of motor seizure, or cumulative seizure duration of a course of ECT, provides a main indicator of beneficial effect (Maletzky, 1978;American Psychiatric Association, 1990), although the duration of the motor seizure is not now felt to be essential (Fear et al, 1994). Although the current ECT Handbook suggests that a seizure of at least 15 seconds peripherally or 25 seconds on EEG is likely to produce a consistently beneficial effect (Scott & Lock, 1995), there is no current substantive evidence for a minimum effective seizure length.…”

Section: Discussionmentioning

confidence: 99%

Inhalation induction with sevoflurane for electroconvulsive therapy: a case series

Palmer¹,

Khalil²,

Meagher³

2004

Psychiatr. bull.

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Aims and MethodUntil 1999, the most common drug for induction of anaesthesia for electroconvulsive therapy (ECT) in the UK was methohexital. Cessation of production left few choices of induction agent. Increased use of sevoflurane in short procedures suggests that it might be suitable as a sole agent for anaesthesia in ECT. We therefore induced anaesthesia in five consecutive patients undergoing ECT to assess sevoflurane's potential for this use. We recorded vital signs, needle phobia, face-mask toleration, duration of induction, seizure duration and recovery variables.ResultsAnaesthesia was successfully induced in all patients without difficulty. One patient experienced mild hypoxia following the seizure. Seizure duration ranged from 24 to 72 seconds. Recovery times to eye opening and times to ‘ward’ fitness were acceptable.Clinical ImplicationsSevoflurane may be a suitable alternative for induction of anaesthesia for ECT.

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“…Although there is no beneficial effect with only one seizure, clinical improvement can be observed with a total seizure time over 210 seconds. 3 Because the seizure is the therapeutic agent, the duration of seizure discharge is the significant variable of therapeutic efficacy. Reducing the duration of convulsive activity in the brain reduces the therapeutic efficacy.…”

Section: Discussionmentioning

confidence: 99%

Anesthesia in Electroconvulsive Therapy

et al. 1999

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Since the 1960s, electroconvulsive therapy (ECT) under general anesthesia with quick-acting barbiturates has been used for the treatment of depression.1 An induction agent should not have undesirable effects on seizure activity, and should achieve rapid induction and easy recovery in order to maintain successful ECT.2 The success of ECT is also closely related to seizure time.3 Stimulation of the autonomic nervous system can cause significant cardiovascular changes. 1,2Many studies have been conducted using etomidate and propofol instead of barbiturates during ECT. When compared to barbiturates, etomidate increased seizure time, whereas propofol decreased it.4-7 Suppression of the ECT-related hypertensive findings by propofol were also noted in these reports. 4,5 In our study, we used thiopentone, etomidate and propofol in succession on each patient. The effect of these agents on motor and electroencephalogram (EEG) seizure times, heart rate, mean blood pressure and peripheral oxygen saturation readings were compared. Materials and MethodsAfter obtaining approval from the Medical Ethics Committee, as well as the patients' consent, 24 patients (8 male and 16 female) who were undergoing ECT treatment for major depression in the ASA I-II group were included in our study. ECT sessions were performed twice a week under the control of a psychiatrist. The patients were not allowed to eat or drink for six hours prior to treatment, and only atropine (0.5 mg/IM) was used for premedication. Their heart rates were then monitored continuously with leads II and V 5 of the electrocardiogram. To determine the orientation level of the patients, a series of 12 questions on personal data (e.g., what is your date of birth?), location (in which country are we now?), and time (do you know the year?) was administered. Patients were ventilated with 100% O 2 for two minutes before the treatment.Thiopentone (T), etomidate (E) and propofol (P) were applied in succession on each patient in order to act as control for the same patient, and to exclude the effect of increased seizure threshold on seizure time. An equal number of anesthesia inductions, in the sequence of T-E-P, E-P-T and P-E-T, were administered.For anesthesia induction, thiopentone (3 mg/kg), etomidate (0.2 mg/kg) and propofol (1 mg/kg) were administered. MECTA SR-2 device was used to apply bilateral frontotemporal ECT after muscle relaxation was achieved by administering succinylcholine chloride (1 mg/kg). During the therapy, the anesthetist used AMBU for the patients' oxygenation. The intensity and duration were kept constant, unless inadequate seizure time (under 20 seconds)-which was measured using bifrontal EEG and tourniquet method-had occurred. During and after the therapy, the heart rate, mean blood pressure, and peripheral oxygen saturation readings were recorded for every patient at 1, 2, 3, 5 and 10 minutes. After the seizures had terminated, the amount of time it took to return to spontaneous respiration, spontaneous opening of the eyelids, and verbal stimulation ...

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Seizure duration and clinical effect in electroconvulsive therapy

Cited by 136 publications

References 16 publications

Comparison of the haemodynamic effects and seizure activity during modified ECT with thiopentone and propofol used as inducing agents.

Comparison of the haemodynamic effects and seizure activity during modified ECT with thiopentone and propofol used as inducing agents.

Inhalation induction with sevoflurane for electroconvulsive therapy: a case series

Anesthesia in Electroconvulsive Therapy

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