The development and retrospective testing of an electroencephalographic seizure quality-based stimulus dosing paradigm with ECT.

Published

Journal Article

The optimization of electroconvulsive therapy (ECT) stimulus dosing remains uncertain. Previous work suggests the potential utility of ictal EEG models of seizure adequacy, but such models have never been tested for their ability to improve the clinical dosing of ECT treatments. Using data from 149 depressed patients, the authors developed an ictal electroencephalographic (EEG) model that can discriminate seizures produced by more therapeutically effective and less efficacious types of stimuli. They retrospectively determined how stimulus dosing according to this seizure adequacy-based model would have differed from that actually used in an additional 61 patients who received ECT according to a standard clinical dose-titration and EEG seizure duration-based dosing strategy. Although the model indicated an increase in stimulus intensity at some point during the ECT treatment course in 23 of 61 patients, only 5 of these 23 actually received a clinical increase in stimulus intensity. The patients who did not receive this increase had a significantly diminished therapeutic response compared with the other patients. Conversely, the model also indicated that an increase in stimulus intensity that occurred clinically might have been unnecessary to achieve therapeutic efficacy in 11% of the patients. This study provides preliminary evidence that ictal EEG models have the potential to make clinically relevant seizure adequacy distinctions among ECT treatments. Further prospective work is indicated to determine the clinical utility of such models.

Full Text

Duke Authors

Cited Authors

  • Krystal, AD; Weiner, RD; Lindahl, V; Massie, R

Published Date

  • December 2000

Published In

Volume / Issue

  • 16 / 4

Start / End Page

  • 338 - 349

PubMed ID

  • 11314871

Pubmed Central ID

  • 11314871

Electronic International Standard Serial Number (EISSN)

  • 1533-4112

International Standard Serial Number (ISSN)

  • 1095-0680

Digital Object Identifier (DOI)

  • 10.1097/00124509-200012000-00003

Language

  • eng