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Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy.

Publication ,  Journal Article
Peterchev, AV; Krystal, AD; Rosa, MA; Lisanby, SH
Published in: Neuropsychopharmacology
August 2015

Electroconvulsive therapy (ECT) at conventional current amplitudes (800-900 mA) is highly effective but carries the risk of cognitive side effects. Lowering and individualizing the current amplitude may reduce side effects by virtue of a less intense and more focal electric field exposure in the brain, but this aspect of ECT dosing is largely unexplored. Magnetic seizure therapy (MST) induces a weaker and more focal electric field than ECT; however, the pulse amplitude is not individualized and the minimum amplitude required to induce a seizure is unknown. We titrated the amplitude of long stimulus trains (500 pulses) as a means of determining the minimum current amplitude required to induce a seizure with ECT (bilateral, right unilateral, bifrontal, and frontomedial electrode placements) and MST (round coil on vertex) in nonhuman primates. Furthermore, we investigated a novel method of predicting this amplitude-titrated seizure threshold (ST) by a non-convulsive measurement of motor threshold (MT) using single pulses delivered through the ECT electrodes or MST coil. Average STs were substantially lower than conventional pulse amplitudes (112-174 mA for ECT and 37.4% of maximum device amplitude for MST). ST was more variable in ECT than in MST. MT explained 63% of the ST variance and is hence the strongest known predictor of ST. These results indicate that seizures can be induced with less intense electric fields than conventional ECT that may be safer; efficacy and side effects should be evaluated in clinical studies. MT measurement could be a faster and safer alternative to empirical ST titration for ECT and MST.

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Published In

Neuropsychopharmacology

DOI

EISSN

1740-634X

Publication Date

August 2015

Volume

40

Issue

9

Start / End Page

2076 / 2084

Location

England

Related Subject Headings

  • Seizures
  • Regression Analysis
  • Psychiatry
  • Motor Activity
  • Male
  • Magnetic Field Therapy
  • Macaca mulatta
  • Electroencephalography
  • Electroconvulsive Therapy
  • Disease Models, Animal
 

Citation

APA
Chicago
ICMJE
MLA
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Peterchev, A. V., Krystal, A. D., Rosa, M. A., & Lisanby, S. H. (2015). Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy. Neuropsychopharmacology, 40(9), 2076–2084. https://doi.org/10.1038/npp.2015.122
Peterchev, Angel V., Andrew D. Krystal, Moacyr A. Rosa, and Sarah H. Lisanby. “Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy.Neuropsychopharmacology 40, no. 9 (August 2015): 2076–84. https://doi.org/10.1038/npp.2015.122.
Peterchev AV, Krystal AD, Rosa MA, Lisanby SH. Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy. Neuropsychopharmacology. 2015 Aug;40(9):2076–84.
Peterchev, Angel V., et al. “Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy.Neuropsychopharmacology, vol. 40, no. 9, Aug. 2015, pp. 2076–84. Pubmed, doi:10.1038/npp.2015.122.
Peterchev AV, Krystal AD, Rosa MA, Lisanby SH. Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy. Neuropsychopharmacology. 2015 Aug;40(9):2076–2084.

Published In

Neuropsychopharmacology

DOI

EISSN

1740-634X

Publication Date

August 2015

Volume

40

Issue

9

Start / End Page

2076 / 2084

Location

England

Related Subject Headings

  • Seizures
  • Regression Analysis
  • Psychiatry
  • Motor Activity
  • Male
  • Magnetic Field Therapy
  • Macaca mulatta
  • Electroencephalography
  • Electroconvulsive Therapy
  • Disease Models, Animal