Factors Predicting Ictal Quality in Bilateral Electroconvulsive Therapy Sessions

In electroconvulsive therapy (ECT), ictal characteristics predict treatment response and can be modified by changes in seizure threshold and in the ECT technique. We aimed to study the impact of ECT procedure-related variables that interact during each session and might influence the seizure results...

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Bibliographic Details
Published in:Brain sciences 2021-06, Vol.11 (6), p.781
Main Authors: de Arriba-Arnau, Aida, Dalmau Llitjos, Antonia, Soria, Virginia, Savino, Stelania, Salvat-Pujol, Neus, Curto, Jordi, Menchón, José Manuel, Urretavizcaya, Mikel
Format: Article
Language:English
Subjects:
Anesthesia
Antidepressants
Benzodiazepines
Convulsions & seizures
Drug dosages
EEG
Electroconvulsive therapy
electroconvulsive therapy (ECT)
Electroencephalography
Heart rate
Hyperventilation
ictal adequacy
Lithium
Muscle relaxants
Oxygen
Patients
postictal suppression
seizure quality
Tricyclic antidepressants
Ventilation
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Summary:In electroconvulsive therapy (ECT), ictal characteristics predict treatment response and can be modified by changes in seizure threshold and in the ECT technique. We aimed to study the impact of ECT procedure-related variables that interact during each session and might influence the seizure results. Two hundred and fifty sessions of bilateral ECT in forty-seven subjects were included. Seizure results were evaluated by two different scales of combined ictal EEG parameters (seizure quality index (SQI) and seizure adequacy markers sum (SAMS) scores) and postictal suppression rating. Repeated measurement regression analyses were performed to identify predictors of each session’s three outcome variables. Univariate models identified age, physical status, hyperventilation, basal oxygen saturation, days between sessions, benzodiazepines, lithium, and tricyclic antidepressants as predictors of seizure quality. Days elapsed between sessions, higher oxygen saturation and protocolized hyperventilation application were significant predictors of better seizure quality in both scales used in multivariate models. Additionally, lower ASA classification influenced SQI scores as well as benzodiazepine use and lithium daily doses were predictors of SAMS scores. Higher muscle relaxant doses and lower applied stimulus intensities significantly influenced the postictal suppression rating. The study found several modifiable procedural factors that impacted the obtained seizure characteristics; they could be adjusted to optimize ECT session results.
ISSN:2076-3425
2076-3425
DOI:10.3390/brainsci11060781