Skip to main content

Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors.

Publication ,  Journal Article
Boylan, LS; Haskett, RF; Mulsant, BH; Greenberg, RM; Prudic, J; Spicknall, K; Lisanby, SH; Sackeim, HA
Published in: J ECT
March 2000

The electrical dosage of the ECT stimulus impacts on efficacy and cognitive side effects, yet seizure threshold (ST) may vary as much as 50-fold across patients. It would be desirable to predict ST on the basis of patient and treatment characteristics. In particular, concerns have been raised that benzodiazepine use and higher dosage of barbiturate anesthetics elevate ST. In a three-site study, ST was quantified at the first ECT session using an identical empirical titration procedure in 294 patients who met RDC and DSM-IIIR criteria for a major depressive episode. ST varied over a 35-fold range across patients treated with right unilateral (RUL) (n = 267) and bilateral (BL) (n = 27) ECT. Higher ST was associated with BL electrode placement (p = 0.001). Among patients treated with RUL ECT, univariate analyses indicated that higher ST was associated with advanced age (p < 0.001), male gender (p < 0.001), greater burden of medical illness (p < 0.001), weight (p < 0.01), duration of mood disorder (p < 0.01), and history of previous ECT (p < 0.05). Average lorazepam dose in the 48 hours prior to ECT was not associated with ST, but was associated with decreased seizure duration (p < 0.01). Absolute, but not weight-adjusted, methohexital dose was associated with ST (p < 0.01). Multivariate analyses in patients treated with unilateral ECT showed that only 27.6% of the variance in ST (p < 0.0001) could be predicted. In the multivariate analyses, only age (p = 0.0001), gender (p = 0.01), and methohexital dose (p = 0.0001) were independently related to ST. Low dosage of lorazepam and methohexital dosage below 1 mg/kg are unlikely to impact on ST. Given the limited capacity to predict ST, empirical titration remains the only accurate method to determine electrical dosage in RUL ECT.

Duke Scholars

Published In

J ECT

DOI

ISSN

1095-0680

Publication Date

March 2000

Volume

16

Issue

1

Start / End Page

3 / 18

Location

United States

Related Subject Headings

  • Titrimetry
  • Seizures
  • Reproducibility of Results
  • Psychiatry
  • Middle Aged
  • Male
  • Humans
  • Female
  • Electroconvulsive Therapy
  • Electric Stimulation
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Boylan, L. S., Haskett, R. F., Mulsant, B. H., Greenberg, R. M., Prudic, J., Spicknall, K., … Sackeim, H. A. (2000). Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors. J ECT, 16(1), 3–18. https://doi.org/10.1097/00124509-200003000-00002
Boylan, L. S., R. F. Haskett, B. H. Mulsant, R. M. Greenberg, J. Prudic, K. Spicknall, S. H. Lisanby, and H. A. Sackeim. “Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors.J ECT 16, no. 1 (March 2000): 3–18. https://doi.org/10.1097/00124509-200003000-00002.
Boylan LS, Haskett RF, Mulsant BH, Greenberg RM, Prudic J, Spicknall K, et al. Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors. J ECT. 2000 Mar;16(1):3–18.
Boylan, L. S., et al. “Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors.J ECT, vol. 16, no. 1, Mar. 2000, pp. 3–18. Pubmed, doi:10.1097/00124509-200003000-00002.
Boylan LS, Haskett RF, Mulsant BH, Greenberg RM, Prudic J, Spicknall K, Lisanby SH, Sackeim HA. Determinants of seizure threshold in ECT: benzodiazepine use, anesthetic dosage, and other factors. J ECT. 2000 Mar;16(1):3–18.

Published In

J ECT

DOI

ISSN

1095-0680

Publication Date

March 2000

Volume

16

Issue

1

Start / End Page

3 / 18

Location

United States

Related Subject Headings

  • Titrimetry
  • Seizures
  • Reproducibility of Results
  • Psychiatry
  • Middle Aged
  • Male
  • Humans
  • Female
  • Electroconvulsive Therapy
  • Electric Stimulation