Advertisement
Original article| Volume 34, ISSUE 11, P759-767, December 01, 1993

The effects of ECT stimulus dose and electrode placement on the Ictal electroencephalogram: An intraindividual crossover study

DOI:https://doi.org/10.1016/0006-3223(93)90064-K
The effects of ECT stimulus dose and electrode placement on the Ictal electroencephalogram: An intraindividual crossover study
Previous ArticleThe effects of fenfluramine on sleep and prolactin in depressed inpatients: A comparison of potential indices of brain serotonergic responsivity
Next ArticleTotal nerve cell number in neocortex in chronic schizophrenics and controls estimated using optical disectors
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Recent evidence suggests that electroconvulsive therapy (ECT) efficacy depends upon both electrode placement and the degree to which stimulus dosage exceeds seizure threshold (T), and not simply on surpassing a minimum seizure duration as has been assumed. In light of these findings and studies reporting ictal electroencephalogram (EEG) differences between bilateral and unilateral ECT, we performed this 19-subject intraindividual crossover study of the effects of dose and electrode placement on the ictal EEG.
      We found ictal EEG evidence of greater seizure intensity with bilateral than unilateral ECT and with higher dosage (2.25 T) compared with barely suprathreshold stimuli. Seizure duration was no longer with bilateral than unilateral ECT and actually decreased with increased dose. A number of ictal EEG variables separated the unilateral 2.25 T and unilateral T conditions, which reportedly differ in efficacy, and therefore, these EEG measures show promise as markers of treatment adequacy.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Biological Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Abrams R.
        A hypothesis to explain the divergent findings among studies comparing the efficacy of unilateral and bilateral ECT in depression.
        Convulsive Ther. 1986; 2: 253-257
        • Abrams R.
        Seizure generalization and unilateral electroconvulsive therapy.
        Conv Ther. 1991; 7: 213-217
        • Abrams R.
        Electroconvulsive Therapy.
        2nd ed. Oxford University Press, New York1992
        • Abrams R.
        • Volavka J.
        • Fink M.
        EEG seizure patterns during multiple unilateral and bilateral ECT.
        Compr Psychiatry. 1973; 14: 25-28
        • American Psychiatric Association
        3rd ed revised. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association, Washington, DC1990
        • Brumback R.A.
        • Staton R.D.
        The electroencephalographic pattern during electroconvulsive therapy.
        Clin Electroencephalogr. 1982; 13: 148-153
        • Cooley J.W.
        • Tukey J.W.
        An algorithm for the machine calculation of complex Fourier Series.
        Math Comput. 1965; 19: 297-301
        • d'Elia G.
        Unilateral electroconvulsive therapy.
        Acta Psychiatr Scand. 1970; 46: 30-97
        • d'Elia G.
        • Perris C.
        Comparison of electroconvulsive therapy with unilateral and bilateral stimulation.
        Acta Psychiatr Scand. 1970; 215: 9-29
        • Gerst J.W.
        • Enderle J.D.
        • Staton R.D.
        • Barr C.E.
        • Brumback R.A.
        The electroencephalographic pattern during electroconvulsive therapy II. Preliminary analysis of spectral energy.
        Clin Electroencephalogr. 1982; 13: 251-256
        • Kirstein L.
        • Ottosson J.O.
        Experimental studies of electroencephalographic changes following electroconvulsive therapy.
        Acta Psychiatr Scand Suppl. 1960; 145: 49-68
        • Kriss A.
        • Halliday A.M.
        • Halliday E.
        • Pratt R.T.C.
        EEG immediately after unilateral ECT.
        Acta Psychiatr Scand. 1978; 58: 231-244
        • Krystal A.D.
        • Weiner R.D.
        The largest Lyapunov exponent of the EEG in ECT seizures.
        in: Duke D.W. Pritchard W.S. Proceedings of the Conference on Measuring Chaos in the Human Brain. World Scientific Publishing, Singapore1991: 113-127
        • Krystal A.D.
        • Weiner R.D.
        • Coffey C.E.
        • Smith P.
        • Arias R.
        • Moffett E.
        EEG evidence of more “intense” seizure activity with bilateral ECT.
        Biol Psychiatry. 1992; 31: 617-621
        • McCall W.V.
        • Shelp F.E.
        • Weiner R.D.
        • Austin S.
        • Norris J.
        Convulsive threshold differences in right unilateral and bilateral ECT.
        Biol Psychiatry. 1993; (In press)
        • Ottosson J.O.
        Effect of lidocaine on the seizure discharge in electroconvulsive therapy.
        Acta Psychiatr Scand Suppl. 1960; 145: 7-32
        • Ottosson J.O.
        Is unilateral nondominant ECT as efficient as bilateral ECT? A new look at the evidence.
        Conv Ther. 1991; 7: 190-200
        • Robin A.
        • Binnie C.D.
        • Copas J.B.
        Electrophysiological and hormonal responses to three types of electroconvulsive therapy.
        Br J Psychiatry. 1985; 147: 707-712
        • Sackeim H.A.
        • Mukherjee S.
        Neurophysiological variability in the effects of the ECT stimulus.
        Conv Ther. 1986; 2: 267-276
        • Sackeim H.A.
        • Decina P.
        • Kanzler M.
        • Kerr B.
        • Malitz S.
        Effects of electrode placement on the efficacy of titrated, low-dose ECT.
        Am J Psychiatry. 1987; 144: 1449-1455
        • Sackeim H.A.
        • Decina P.
        • Prohovnik I.
        • Malitz S.
        • Resor S.R.
        Anticonvulsant and antidepressant properties of electroconvulsive therapy: A proposed mechanism of action. 1983; 18: 1301-1310
        • Sackeim H.A.
        • Devanand D.P.
        • Prudic J.
        Stimulus intensity, seizure threshold, and seizure duration: Impact on the efficacy and safety of electroconvulsive therapy.
        Psychiatr Clin North Am. 1991; 14: 803-843
        • Sackeim H.A.
        • Nobler M.S.
        • Prudic J.
        • et al.
        Acute effects of electroconvulsive therapy on hemispatial neglect.
        Neuropsychiatry Neuropsychol Behav Neurol. 1992; 5: 151-160
        • Sackeim H.A.
        • Prudic J.
        • Devannand D.P.
        • et al.
        Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy.
        N Engl J Med. 1993; 328: 839-846
        • Small J.G.
        • Small I.F.
        • Perez H.C.
        • Sharpley P.
        Electroencephalographic and neurophysiological studies of electrically induced seizures.
        J Nerv Ment Dis. 1970; 150: 479-489
        • Staton R.D.
        • Hass P.J.
        • Brumback R.A.
        Electroencephalographic recording during bitemporal and unilateral non-dominant hemisphere (Lancaster position) electroconvulsive therapy.
        J Clin Psychiatry. 1981; 42: 264-273
        • Staton R.D.
        • Enderle J.D.
        • Gerst J.W.
        The electroencephalographic pattern during electroconvulsive therapy IV. Spectral energy distributions with methohexital, innovar, and ketamine anesthesias.
        Clin Electroencephalogr. 1986; 17: 203-215
        • Swartz C.M.
        • Larson G.
        Generalization of the effects of unilateral and bilateral ECT.
        Am J Psychiatry. 1986; 143: 1040-1041
        • Weaver L.
        • Williams R.
        • Rush S.
        Current density in bilateral and unilateral ECT.
        Biol Psychiatry. 1976; 11: 303-312
        • Weiner R.D.
        ECT and seizure threshold: Effects of stimulus waveform and electrode placement.
        Biol Psychiatry. 1980; 15: 225-241
        • Weiner R.D.
        • Krystal A.D.
        EEG Monitoring of ECT seizures.
        in: Coffey C.E. The Clinical Science of Electroconvulsive Therapy. American Psychiatric Press, Washington, DC1993
        • Weiner R.D.
        • Rogers H.J.
        • Davidson J.R.T.
        • Kahm E.M.
        Effects of electroconvulsive therapy upon brain electrical activity.
        in: Malitz S. Sackeim H. Electroconvulsive therapy: Clinical and basic research issues. Ann N Y Acad Sci. 462. 1986: 270-281
        • Weiner R.D.
        • Rogers H.J.
        • Davidson J.R.T.
        • Squire L.R.
        Effects of stimulus parameters on cognitive side effects.
        in: Malitz S. Sackeim H. Electroconvulsive therapy: Clinical and basic research issues. Ann N Y Acad Sci. 462. 1986: 315-325
        • Weiner R.D.
        • Coffey C.E.
        • Krystal A.D.
        The monitoring and management of electrically induced seizures.
        Psychiatr Clin North Am. 1991; 14: 845-869

      Article info

      Publication history

      Received in revised form: August 20, 1993
      Received: October 15, 1992

      Footnotes

      ☆T P

      Identification

      DOI: https://doi.org/10.1016/0006-3223(93)90064-K

      Copyright

      © 1993 Published by Elsevier Inc.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX