Severe Postictal Confusion After Electroconvulsive Therapy

Schuur, Gijsbert; Verdijk, Joey; Doesschate, Freek ten; Wingen, Guido A. van; Waarde, Jeroen A. van

doi:10.1097/yct.0000000000000866

Cited by 4 publications

(4 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For example, we did not include the indications for concomitant use of acetaminophen, NSAIDs and calcium antagonists (e.g., cardiovascular and rheumatological illnesses) in our analyses, while these comorbidities are probably associated with (more) use of antihypertensive medications and analgesics. Third, we used a definition of a relatively severe occurrence of postictal confusion ( 7 ). Therefore, our results cannot be extrapolated to more subtle forms of postictal confusion.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have addressed postictal confusion and cognitive side-effects of ECT ( 5 , 6 ). Clinical research has not provided robust predictors for the occurrence of postictal confusion ( 7 , 8 ). Age, pre-existent cognitive problems, used electrode placement, number of administered ECT-sessions, and persisting depressive symptoms after ECT were described as determinants of cognitive outcome of ECT.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study

Verdijk

Schuur²,

Pottkämper³

et al. 2023

Front. Psychiatry

View full text Add to dashboard Cite

BackgroundElectroconvulsive therapy (ECT) is associated with postictal confusion and cognitive side-effects. In rats, acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) and calcium antagonists decreased postictal cerebral hypoperfusion along with reduction in postictal symptoms. In this study, in ECT-patients, we explore associations between use of these potentially protective medications and occurrence of postictal confusion and cognitive outcome.Materials and methodsIn this retrospective, naturalistic cohort study, patient-, treatment-, and ECT-characteristics, were collected from medical files of patients treated with ECT for major depressive disorder (MDD) or bipolar depressive episode. To test for associations of use of these medications with occurrence of postictal confusion, 295 patients could be included. Cognitive outcome data were available in a subset of 109 patients. Univariate analyses and multivariate censored regression models were used to test for associations.ResultsOccurrence of severe postictal confusion was not associated with use of acetaminophen, NSAIDs or calcium antagonists (n = 295). Regarding the cognitive outcome measure (n = 109), use of calcium antagonists was associated with higher post-ECT cognitive scores (i.e., better cognitive outcome; β = 2.23; p = 0.047), adjusted for age (β = −0.02; p = 0.23), sex (β = −0.21; p = 0.73), pre-ECT cognitive score (β = 0.47; p < 0.0001), and post-ECT depression score (β = −0.02; p = 0.62), but use of acetaminophen (β = −1.55; p = 0.07) as well as NSAIDs (β = −1.02; p = 0.23) showed no associations.ConclusionThis retrospective study does not find arguments for protective effects of acetaminophen, NSAIDs or calcium antagonists against severe postictal confusion in ECT. As a preliminary finding, the use of calcium antagonists was associated with improved cognitive outcome after ECT in this cohort. Prospective controlled studies are necessary.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study

Verdijk

Schuur²,

Pottkämper³

et al. 2023

Front. Psychiatry

View full text Add to dashboard Cite

show abstract

“…As seen in Supplementary Table 2 , none of the included studies clearly defined the psychiatric indication for ECT, management of agitation prior to ECT or in between sessions, the ECT procedure, or any other possible risk factors for PIA that could confound the results. These risk factors include gender ( 6 , 35 ), concomitant lithium or SSRI use ( 6 , 36 ), and substance use disorder ( 35 ). The generalizability of the results is questionable as most studies were performed in Asia [except for one Egyptian study ( 29 )], and mostly young healthy patients or patients with mild systemic disease (ASA II) were included.…”

Section: Discussionmentioning

confidence: 99%

Pharmacological prevention of postictal agitation after electroconvulsive therapy—A systematic review and meta-analysis

et al. 2023

View full text Add to dashboard Cite

BackgroundPostictal agitation (PIA) after electroconvulsive therapy (ECT) is a serious clinical problem estimated to occur in 7–36% of patients and recur in 19–54% of patients. PIA has the potential to cause dangerous situations for the patient and staff members aside from the financial impact. To date, it is unclear which pharmacological interventions should be used in the management of PIA. This study aimed to systematically review the (preventative) pharmacological treatment options for PIA after ECT.MethodA systematic search was done in PubMed, EMBASE, PsycINFO, and Web of Science from inception until 10 November 2022. We included randomized trials with any pharmacological intervention or comparison and a predefined outcome measure on PIA. Studies that solely included patients with neurodegenerative disorders or stroke were excluded. Data quality was assessed with the RoB2 and GRADE. Meta-analysis was performed if possible. This study was registered on PROSPERO under CRD42021262323.ResultsWe screened 2,204 articles and included 14 studies. Dexmedetomidine was investigated in 10 studies. Alfentanil, lignocaine, esmolol, midazolam, propofol, ketamine, haloperidol, and diazepam were each studied in only one study. Meta-analysis revealed an OR of 0.45 (0.32–0.63), a moderate effect size, in favor of dexmedetomidine than placebo to prevent PIA with very low heterogeneity (I2 = 0%). The certainty of the evidence was moderate. The other interventions studied were all found to have low certainty of evidence.ConclusionFor clinical practice, we believe that our results indicate that dexmedetomidine should be considered for the prevention of PIA in patients that have previously experienced PIA.

show abstract

“…Anesthesia was mostly achieved using etomidate (0.2–0.3 mg/kg body weight) for sedation and succinylcholine (0.5–1 mg/kg) for muscle relaxation. In case of severe postictal confusion, defined as the clinical necessity to administer sedatives or restraints due to severe motor restlessness, disorientation, agitation, or anxiety [ 22 ]), midazolam (2.5–5 mg intravenously) was used. Cessation of the ECT course was clinically decided by the treating psychiatrists and rated with the Hamilton Depression Rating Scale (HDRS) [ 23 ].…”

Section: Methodsmentioning

confidence: 99%

Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and time

Stuiver,

Pottkämper,

Verdijk

et al. 2024

Eur. Psychiatr.

Self Cite

View full text Add to dashboard Cite

Background. Most patients show temporary impairments in clinical orientation after electroconvulsive therapy (ECT)-induced seizures. It is unclear how postictal reorientation relates to electroencephalography (EEG) restoration. This relationship may provide additional measures to quantify postictal recovery and shed light on neurophysiological aspects of reorientation after ECT. Methods. We analyzed prospectively collected clinical and continuous ictal and postictal EEG data from ECT patients. Postictal EEG restoration up to 1 h was estimated by the evolution of the normalized alpha-delta ratio (ADR). Times to reorientation in the cognitive domains of person, place, and time were assessed postictally. In each cognitive domain, a linear mixed model was fitted to investigate the relationships between time to reorientation and postictal EEG restoration. Results. In total, 272 pairs of ictal-postictal EEG and reorientation times of 32 patients were included. In all domains, longer time to reorientation was associated with slower postictal EEG recovery. Longer seizure duration and postictal administration of midazolam were related to longer time to reorientation in all domains. At 1-hour post-seizure, most patients were clinically reoriented, while their EEG had only partly restored. Conclusions. We show a relationship between postictal EEG restoration and clinical reorientation after ECT-induced seizures. EEG was more sensitive than reorientation time in all domains to detect postictal recovery beyond 1-hour post-seizure. Our findings indicate that clinical reorientation probably depends on gradual cortical synaptic recovery, with longer seizure duration leading to longer postsynaptic suppression after ECT seizures.

show abstract

Severe Postictal Confusion After Electroconvulsive Therapy

Cited by 4 publications

References 34 publications

Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study

Medication preventing postictal hypoperfusion and cognitive side-effects in electroconvulsive therapy: A retrospective cohort study

Pharmacological prevention of postictal agitation after electroconvulsive therapy—A systematic review and meta-analysis

Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and time

Contact Info

Product

Resources

About