Seizure threshold in electroconvulsive therapy: I. Initial seizure threshold

Coffey, C. Edward; Lucke, Joseph F.; Weiner, Richard D.; Krystal, Andrew D.; Aque, Michael

doi:10.1016/0006-3223(95)00262-f

Cited by 132 publications

(82 citation statements)

References 34 publications

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“…We observed inverse dependencies of motor and EEG seizure duration on age, as well as of EEG seizure duration on individual ST, consistent with clinical ECT with conventional dosing strategies (Boylan et al, 2000;Chung, 2002;Coffey et al, 1995;Rasimas et al, 2007). The reported significant interaction effect of session and stimulation modality on EEG seizure duration may be due to particularly long seizures occurring in arbitrary sessions that are different across the modalities.…”

Section: Seizure Durationsupporting

confidence: 77%

“…The predictors of motor and EEG seizure duration were analyzed similarly with a multiple regression with factors including stimulation modality as well as normalized ST, session number, age, weight and their interaction with stimulation modality. The seizure duration data were log-transformed to reduce the skewness of the distribution (Coffey et al, 1995). These multivariate analyses were followed up by Tukey's HSD test or Student's t-test to compare specific conditions.…”

Section: Discussionmentioning

confidence: 99%

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

Peterchev

Krystal

Rosa³

et al. 2015

Neuropsychopharmacol

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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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Section: Seizure Durationsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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

Peterchev

Krystal

Rosa³

et al. 2015

Neuropsychopharmacol

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“…ST is markedly higher with BL than RUL ECT (Sackeim et al, 1987a, b;McCall et al, 1993), with sine wave than brief pulse stimulation (Weiner, 1980), and with brief pulse than ultra-brief pulse stimulation. There are also marked individual differences in ST, which increases with age and is higher in men than women (Sackeim et al, 1987b;Coffey et al, 1995;Colenda and McCall, 1996;Lisanby et al, 1996;Boylan et al, 2000). ST also has an inverse association with ECT seizure duration, validating that this measure reflects individual differences in neural excitability.…”

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

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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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“…Several predictors of ST have been repeatedly replicated in considerably large samples, although the variance in ST explained by them is modest [8,11,12]. Male gender, older age and bitemporal (BT) (vs unilateral) electrode placement have been found to predict higher ST [12,16,17]. It has been classically believed that benzodiazepines and anticonvulsants increase ST [3,18,19], though the effect of these medications on ST has not been systematically examined in humans.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Seizure Threshold in Right Unilateral Ultrabrief Electroconvulsive Therapy: Role of Concomitant Medications and Anaesthesia Used

et al. 2015

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Seizure threshold in electroconvulsive therapy: I. Initial seizure threshold

Cited by 132 publications

References 34 publications

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

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

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

Predictors of Seizure Threshold in Right Unilateral Ultrabrief Electroconvulsive Therapy: Role of Concomitant Medications and Anaesthesia Used

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