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Seizure threshold increases can be predicted by EEG quality in right unilateral ultrabrief ECT
Increases in seizure threshold (ST) over a course of brief pulse ECT can be predicted by decreases in EEG quality, informing ECT dose adjustment to maintain adequate supra-threshold dosing. ST increases also occur over a course of right unilateral ultrabrief (RUL UB) ECT, but no data exist on the re...
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| Published in: | European archives of psychiatry and clinical neuroscience 2017-12, Vol.267 (8), p.795-801 |
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| creator | Gálvez, Verònica Hadzi-Pavlovic, Dusan Waite, Susan Loo, Colleen K. |
| description | Increases in seizure threshold (ST) over a course of
brief
pulse ECT can be predicted by decreases in EEG quality, informing ECT dose adjustment to maintain adequate supra-threshold dosing. ST increases also occur over a course of right unilateral
ultrabrief
(RUL UB) ECT, but no data exist on the relationship between ST increases and EEG indices. This study (
n
= 35) investigated if increases in ST over RUL UB ECT treatments could be predicted by a decline in seizure quality. ST titration was performed at ECT session one and seven, with treatment dosing maintained stable (at 6–8 times ST) in intervening sessions. Seizure quality indices (slow-wave onset, mid-ictal amplitude, regularity, stereotypy, and post-ictal suppression) were manually rated at the first supra-threshold treatment, and last supra-threshold treatment before re-titration, using a structured rating scale, by a single trained rater blinded to the ECT session being rated. Twenty-one subjects (60%) had a ST increase. The association between ST changes and EEG quality indices was analysed by logistic regression, yielding a significant model (
p
|
| doi_str_mv | 10.1007/s00406-017-0777-y |
| format | article |
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brief
pulse ECT can be predicted by decreases in EEG quality, informing ECT dose adjustment to maintain adequate supra-threshold dosing. ST increases also occur over a course of right unilateral
ultrabrief
(RUL UB) ECT, but no data exist on the relationship between ST increases and EEG indices. This study (
n
= 35) investigated if increases in ST over RUL UB ECT treatments could be predicted by a decline in seizure quality. ST titration was performed at ECT session one and seven, with treatment dosing maintained stable (at 6–8 times ST) in intervening sessions. Seizure quality indices (slow-wave onset, mid-ictal amplitude, regularity, stereotypy, and post-ictal suppression) were manually rated at the first supra-threshold treatment, and last supra-threshold treatment before re-titration, using a structured rating scale, by a single trained rater blinded to the ECT session being rated. Twenty-one subjects (60%) had a ST increase. The association between ST changes and EEG quality indices was analysed by logistic regression, yielding a significant model (
p
< 0.001). Initial ST (
p
< 0.05) and percentage change in mid-ictal amplitude (
p
< 0.05) were significant predictors of change in ST. Percentage change in post-ictal suppression reached trend level significance (
p
= 0.065). Increases in ST over a RUL UB ECT course may be predicted by decreases in seizure quality, specifically decline in mid-ictal amplitude and potentially in post-ictal suppression. Such EEG indices may be able to inform when dose adjustments are necessary to maintain adequate supra-threshold dosing in RUL UB ECT.</description><identifier>ISSN: 0940-1334</identifier><identifier>EISSN: 1433-8491</identifier><identifier>DOI: 10.1007/s00406-017-0777-y</identifier><identifier>PMID: 28401340</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Cerebral Cortex - physiopathology ; Convulsions & seizures ; EEG ; Electroconvulsive therapy ; Electroconvulsive Therapy - methods ; Electroencephalography - methods ; Female ; Humans ; Male ; Medicine ; Medicine & Public Health ; Mental Disorders - therapy ; Middle Aged ; Neurosciences ; Original Paper ; Psychiatry ; Quality ; Seizures - physiopathology ; Titration</subject><ispartof>European archives of psychiatry and clinical neuroscience, 2017-12, Vol.267 (8), p.795-801</ispartof><rights>Springer-Verlag Berlin Heidelberg 2017</rights><rights>European Archives of Psychiatry and Clinical Neuroscience is a copyright of Springer, 2017.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-927d31c1f041fdc6e43bad3906407fba39634df0f48ca2e6f688930858cd253a3</citedby><cites>FETCH-LOGICAL-c372t-927d31c1f041fdc6e43bad3906407fba39634df0f48ca2e6f688930858cd253a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28401340$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gálvez, Verònica</creatorcontrib><creatorcontrib>Hadzi-Pavlovic, Dusan</creatorcontrib><creatorcontrib>Waite, Susan</creatorcontrib><creatorcontrib>Loo, Colleen K.</creatorcontrib><title>Seizure threshold increases can be predicted by EEG quality in right unilateral ultrabrief ECT</title><title>European archives of psychiatry and clinical neuroscience</title><addtitle>Eur Arch Psychiatry Clin Neurosci</addtitle><addtitle>Eur Arch Psychiatry Clin Neurosci</addtitle><description>Increases in seizure threshold (ST) over a course of
brief
pulse ECT can be predicted by decreases in EEG quality, informing ECT dose adjustment to maintain adequate supra-threshold dosing. ST increases also occur over a course of right unilateral
ultrabrief
(RUL UB) ECT, but no data exist on the relationship between ST increases and EEG indices. This study (
n
= 35) investigated if increases in ST over RUL UB ECT treatments could be predicted by a decline in seizure quality. ST titration was performed at ECT session one and seven, with treatment dosing maintained stable (at 6–8 times ST) in intervening sessions. Seizure quality indices (slow-wave onset, mid-ictal amplitude, regularity, stereotypy, and post-ictal suppression) were manually rated at the first supra-threshold treatment, and last supra-threshold treatment before re-titration, using a structured rating scale, by a single trained rater blinded to the ECT session being rated. Twenty-one subjects (60%) had a ST increase. The association between ST changes and EEG quality indices was analysed by logistic regression, yielding a significant model (
p
< 0.001). Initial ST (
p
< 0.05) and percentage change in mid-ictal amplitude (
p
< 0.05) were significant predictors of change in ST. Percentage change in post-ictal suppression reached trend level significance (
p
= 0.065). Increases in ST over a RUL UB ECT course may be predicted by decreases in seizure quality, specifically decline in mid-ictal amplitude and potentially in post-ictal suppression. Such EEG indices may be able to inform when dose adjustments are necessary to maintain adequate supra-threshold dosing in RUL UB ECT.</description><subject>Adult</subject><subject>Aged</subject><subject>Cerebral Cortex - physiopathology</subject><subject>Convulsions & seizures</subject><subject>EEG</subject><subject>Electroconvulsive therapy</subject><subject>Electroconvulsive Therapy - methods</subject><subject>Electroencephalography - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mental Disorders - therapy</subject><subject>Middle Aged</subject><subject>Neurosciences</subject><subject>Original Paper</subject><subject>Psychiatry</subject><subject>Quality</subject><subject>Seizures - physiopathology</subject><subject>Titration</subject><issn>0940-1334</issn><issn>1433-8491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNp1kMFO3DAQhi1EBVvaB-ilssSFS9px7MT2Ea22tBISB-CK5dhj1iibLHZySJ--RgtVhdTTHOb7_xl9hHxh8I0ByO8ZQEBbAZMVSCmr5YismOC8UkKzY7ICLaBinItT8jHnJwBgTQ0n5LRWAhgXsCIPtxh_zwnptE2Yt2PvaRxcQpsxU2cH2iHdJ_TRTehpt9DN5oo-z7aP01JImuLjdqLzEHs7YbI9nfsp2S5FDHSzvvtEPgTbZ_z8Os_I_Y_N3fpndX1z9Wt9eV05Luup0rX0nDkWQLDgXYuCd9ZzDa0AGTrLdcuFDxCEcrbGNrRKaQ6qUc7XDbf8jFwcevdpfJ4xT2YXs8O-twOOczZMKQmNaKQu6Pk79Gmc01C-M0w3smCNZoViB8qlMeeEwexT3Nm0GAbmRb45yDdFvnmRb5aS-fraPHc79H8Tb7YLUB-AXFbDI6Z_Tv-39Q9aBY7X</recordid><startdate>20171201</startdate><enddate>20171201</enddate><creator>Gálvez, Verònica</creator><creator>Hadzi-Pavlovic, Dusan</creator><creator>Waite, Susan</creator><creator>Loo, Colleen K.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>20171201</creationdate><title>Seizure threshold increases can be predicted by EEG quality in right unilateral ultrabrief ECT</title><author>Gálvez, Verònica ; Hadzi-Pavlovic, Dusan ; Waite, Susan ; Loo, Colleen K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-927d31c1f041fdc6e43bad3906407fba39634df0f48ca2e6f688930858cd253a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Cerebral Cortex - physiopathology</topic><topic>Convulsions & seizures</topic><topic>EEG</topic><topic>Electroconvulsive therapy</topic><topic>Electroconvulsive Therapy - methods</topic><topic>Electroencephalography - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mental Disorders - therapy</topic><topic>Middle Aged</topic><topic>Neurosciences</topic><topic>Original Paper</topic><topic>Psychiatry</topic><topic>Quality</topic><topic>Seizures - physiopathology</topic><topic>Titration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gálvez, Verònica</creatorcontrib><creatorcontrib>Hadzi-Pavlovic, Dusan</creatorcontrib><creatorcontrib>Waite, Susan</creatorcontrib><creatorcontrib>Loo, Colleen K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Psychology Database (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>European archives of psychiatry and clinical neuroscience</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gálvez, Verònica</au><au>Hadzi-Pavlovic, Dusan</au><au>Waite, Susan</au><au>Loo, Colleen K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Seizure threshold increases can be predicted by EEG quality in right unilateral ultrabrief ECT</atitle><jtitle>European archives of psychiatry and clinical neuroscience</jtitle><stitle>Eur Arch Psychiatry Clin Neurosci</stitle><addtitle>Eur Arch Psychiatry Clin Neurosci</addtitle><date>2017-12-01</date><risdate>2017</risdate><volume>267</volume><issue>8</issue><spage>795</spage><epage>801</epage><pages>795-801</pages><issn>0940-1334</issn><eissn>1433-8491</eissn><abstract>Increases in seizure threshold (ST) over a course of
brief
pulse ECT can be predicted by decreases in EEG quality, informing ECT dose adjustment to maintain adequate supra-threshold dosing. ST increases also occur over a course of right unilateral
ultrabrief
(RUL UB) ECT, but no data exist on the relationship between ST increases and EEG indices. This study (
n
= 35) investigated if increases in ST over RUL UB ECT treatments could be predicted by a decline in seizure quality. ST titration was performed at ECT session one and seven, with treatment dosing maintained stable (at 6–8 times ST) in intervening sessions. Seizure quality indices (slow-wave onset, mid-ictal amplitude, regularity, stereotypy, and post-ictal suppression) were manually rated at the first supra-threshold treatment, and last supra-threshold treatment before re-titration, using a structured rating scale, by a single trained rater blinded to the ECT session being rated. Twenty-one subjects (60%) had a ST increase. The association between ST changes and EEG quality indices was analysed by logistic regression, yielding a significant model (
p
< 0.001). Initial ST (
p
< 0.05) and percentage change in mid-ictal amplitude (
p
< 0.05) were significant predictors of change in ST. Percentage change in post-ictal suppression reached trend level significance (
p
= 0.065). Increases in ST over a RUL UB ECT course may be predicted by decreases in seizure quality, specifically decline in mid-ictal amplitude and potentially in post-ictal suppression. Such EEG indices may be able to inform when dose adjustments are necessary to maintain adequate supra-threshold dosing in RUL UB ECT.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>28401340</pmid><doi>10.1007/s00406-017-0777-y</doi><tpages>7</tpages></addata></record> |
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| subjects | Adult Aged Cerebral Cortex - physiopathology Convulsions & seizures EEG Electroconvulsive therapy Electroconvulsive Therapy - methods Electroencephalography - methods Female Humans Male Medicine Medicine & Public Health Mental Disorders - therapy Middle Aged Neurosciences Original Paper Psychiatry Quality Seizures - physiopathology Titration |
| title | Seizure threshold increases can be predicted by EEG quality in right unilateral ultrabrief ECT |
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