Is postictal electrical silence a predictor of response to electroconvulsive therapy?

Suppes, Trisha; Webb, Andrew; Carmody, Thomas; Gordon, Eunice; Gutierrez-Esteinou, Rolando; Hudson, James I.; Pope, Harrison G.

doi:10.1016/0165-0327(96)00066-3

Cited by 85 publications

(42 citation statements)

References 8 publications

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“…Higher dosage treatment produces more intense ictal EEG expression and greater postictal suppression (Krystal et al, 1993(Krystal et al, , 2000bNobler et al, 1993Nobler et al, , 2000Luber et al, 2000). Consistent with this pattern, several studies found that patients with superior clinical outcome had greater ictal amplitude, especially in the d frequency band, and greater postictal suppression (Nobler et al, 1993Krystal et al, 1995Krystal et al, , 2000aFolkerts, 1996;Suppes et al, 1996;Luber et al, 2000). ECT devices now provide quantitative analyses of the ictal and postictal EEG, in the form of power and coherence values for specific frequency bands, or as composite indices intended to quantify 'seizure adequacy' and predict treatment outcome.…”

Section: Introductionsupporting

confidence: 54%

“…However, prior research on dosage effects was limited by a focus on the differences of RUL ECT at barely suprathreshold dosage compared to higher dosage conditions (Krystal et al, 1993(Krystal et al, , 2000bNobler et al, 1993;Luber et al, 2000). Especially problematic for this account have been reports that the same peri-ictal features are also associated with the efficacy of BL ECT (Nobler et al, 1993Folkerts, 1996;Hrdlicka et al, 1996;Suppes et al, 1996), which is far less sensitive than RUL ECT to effects of dosage on efficacy (Sackeim et al, 1987a.…”

Section: Discussionmentioning

confidence: 99%

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Seizure Expression During Electroconvulsive Therapy: Relationships with Clinical Outcome and Cognitive Side Effects

Perera

Luber

Nobler

et al. 2004

Neuropsychopharmacol

128

102

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Since electroconvulsive therapy (ECT) can result in generalized seizures that lack efficacy, physiological markers of treatment adequacy are needed. Specific electroencephalographic (EEG) features differentiate seizures produced with barely suprathreshold right unilateral (RUL) ECT, an ineffective treatment, from effective forms of ECT. This study determined whether EEG features are sensitive to treatment condition using a broad dosing range for RUL ECT, as well as predictive of clinical and cognitive outcomes. Quantitative EEG measures and observer ratings were compared in predictive power. From a larger study, 54 in-patients with major depression were randomized to low (1.5 Â seizure threshold (ST)), moderate (2.5 Â ST), or high-dose (6 Â ST) RUL ECT, or high-dose (2.5 Â ST) bilateral (BL) ECT. High dosage RUL and BL ECT were comparable in efficacy, and superior to low and moderate dosage RUL ECT. In the slow frequency bands (d), BL ECT resulted in greater ictal power, ictal coherence, and postictal suppression than each RUL ECT condition, but the EEG measures failed to discriminate the RUL ECT groups. EEG measures were modestly associated with clinical outcome, with greater ictal power, d coherence, and postictal suppression positive predictors. None of the EEG measures were associated with cognitive outcomes. Inability to distinguish forms of RUL ECT differing markedly in dosage and efficacy suggests that EEG measures have limited potential as markers of treatment adequacy. Rather than assaying treatment adequacy, the EEG features associated with efficacy may reflect individual differences in the strength of inhibitory processes that terminate the seizure, and can help isolate the biological variability that predisposes to positive or negative clinical response to ECT.

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Section: Introductionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Seizure Expression During Electroconvulsive Therapy: Relationships with Clinical Outcome and Cognitive Side Effects

Perera

Luber

Nobler

et al. 2004

Neuropsychopharmacol

128

102

View full text Add to dashboard Cite

show abstract

“…It has been reported that certain ictal and postictal EEG changes, such as the degree of ictal expression and postictal suppression, are correlated with the efficacy of conventional ECT (Folkerts, 1996;Krystal et al, 1995;Nobler et al, 1993;Suppes et al, 1996). Whether these same relationships will pertain to MST is unknown.…”

Section: Discussionmentioning

confidence: 85%

Safety and Feasibility of Magnetic Seizure Therapy (MST) in Major Depression: Randomized Within-Subject Comparison with Electroconvulsive Therapy

Lisanby

Luber

Schläepfer³

et al. 2003

Neuropsychopharmacol

233

170

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Magnetic seizure therapy (MST) is a novel means of performing convulsive therapy using rapidly alternating strong magnetic fields. MST offers greater control of intracerebral current intensity than is possible with electroconvulsive therapy (ECT). These features may result in a superior cognitive side effect profile for MST, while possibly retaining the efficacy of ECT. The objective of this study was to determine whether MST and ECT differ in seizure characteristics, and acute objective and subjective cognitive side effects. A total of 10 inpatients in a major depressive episode referred for ECT were enrolled in this randomized, within-subject, double-masked trial. Seizure threshold was determined with MST and ECT in the first two sessions of a course of convulsive therapy, with order randomized. The remaining two sessions consisted of suprathreshold stimulation with MST and ECT. A neuropsychological battery and side effect rating scale were administered by a masked rater before and after each session. Tonic-clonic seizures were elicited with MST in all patients. Compared to ECT, MST seizures had shorter duration, lower ictal EEG amplitude, and less postictal suppression. Patients had fewer subjective side effects and recovered orientation more quickly with MST than ECT. MST was also superior to ECT on measures of attention, retrograde amnesia, and category fluency. Magnetic seizure induction in patients with depression is feasible, and appears to have a superior acute side effect profile than ECT. Future research will be needed to establish whether MST has antidepressant efficacy.

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“…To evaluate the ECT treatment quality, other electrophysiological parameters and indices of prospective clinical significance were also used (Swartz et al 1986;Weiner et al 1991;Nobler et al 1993;Suppes et al 1996). In our study the PSI, which indicates a positive correlation with clinical effectiveness (Suppes et al 1996), was significantly enhanced in comparison to treatments without psychotropic pharmacotherapy if SSRI or SNRI treatment were prescribed at the same time.…”

Section: Discussionmentioning

confidence: 93%

“…The index is calculated from the quotient of the mean EEG amplitude during a 3-s derivation 0.5 s after the end of convulsions and the mean amplitude of a 3-s passage during the convulsions. Its unit ''% suppression'' is highly correlated to the probability of clinical improvement (Suppes et al 1996). Restimulation is recommended if the PSI is under 80% (Weiner et al 1991;Nobler et al 1993).…”

Section: Electrophysiological Measuresmentioning

confidence: 99%

The influence of concomitant antidepressant medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy

Baghai

Marcuse

Brosch

et al. 2006

The World Journal of Biological Psychiatry

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Is postictal electrical silence a predictor of response to electroconvulsive therapy?

Cited by 85 publications

References 8 publications

Seizure Expression During Electroconvulsive Therapy: Relationships with Clinical Outcome and Cognitive Side Effects

Seizure Expression During Electroconvulsive Therapy: Relationships with Clinical Outcome and Cognitive Side Effects

Safety and Feasibility of Magnetic Seizure Therapy (MST) in Major Depression: Randomized Within-Subject Comparison with Electroconvulsive Therapy

The influence of concomitant antidepressant medication on safety, tolerability and clinical effectiveness of electroconvulsive therapy

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