The effect of psychotropic medication on seizure duration during bilateral electroconvulsive therapy: a retrospective study

Abstract

A five-year retrospective study investigating the effects of psychotropic medication on first seizure length was undertaken on 109 patients who received 131 courses of electroconvulsive therapy (ECT). Bilateral ECT was administered under methohexitone anaesthesia. Induction of a seizure was successful in 105 patients. Stepwise linear regression analysis showed that except for selective serotonin reuptake inhibitors (SSRIs) seizure length was not affected by psychotropic medication, SSRIs were associated with prolonged seizure length (p=0.0012). Less than one-third of the subjects had drugs with anticonvulsant properties omitted before treatment. Drugs with anticonvulsant properties did not shorten seizure length. Though this study suggests that SSRIs may prolong fit length, further clarification of the predictors for seizure duration is required.

Tardive Seizures After Electroconvulsive Therapy

“…57 However, there is significant variability between studies, and multiple large studies reviewing these medications in ECT do not demonstrate any adverse seizure effects, in particular no increased rates of tardive seizures or incidence of post-ECT epilepsy. 62,64 Seizure risk may increase from withholding or recent cessation of seizureprotective medications such as antiepileptics and benzodiazepines (12 cases), especially in those with underlying medical risk factors. Hyperoxygenation, smoking, caffeine consumption, and iron deficiency, which were often not considered in these cases or poorly documented, may also alter seizure threshold pathology.…”

“…This is often a dose- and speed of titration–dependent effect 57 . However, there is significant variability between studies, and multiple large studies reviewing these medications in ECT do not demonstrate any adverse seizure effects, in particular no increased rates of tardive seizures or incidence of post-ECT epilepsy 62,64 . Seizure risk may increase from withholding or recent cessation of seizure-protective medications such as antiepileptics and benzodiazepines (12 cases), especially in those with underlying medical risk factors.…”