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PubMed · 7834260

Visually determined high-frequency seizure activity.

C M Swartz·R Abrams·K Rasmussen·C F Zorumski
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Abstract

The duration of high-frequency electroconvulsive therapy (ECT) seizure activity, the "spike seizure duration," was rated by two experienced clinicians from the paper EEG recording, along with total EEG seizure duration. The spike seizure duration, taken together with other seizure duration measurements, has shown differences between ECT methods of apparently different efficacy, such as unilateral and bilateral ECT. Close correspondence between the raters demonstrated high reliability for the determination of spike seizure duration, with interrater reliability kappa of 0.92 (p < 10(-6), although the raters employed different rules for selecting the end point.

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Electroconvulsive TherapyElectroencephalographyEvoked PotentialsFrontal LobeHumansMonitoring, PhysiologicObserver VariationClinical TrialJournal ArticleRandomized Controlled Trial

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BibTeXRIS

C M Swartz, R Abrams, K Rasmussen, C F Zorumski. 1994. Visually determined high-frequency seizure activity.. https://pubmed.ncbi.nlm.nih.gov/7834260/

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PubMed2006

Recent advances in optimizing electroconvulsive therapy.

This review aims to summarize and critically evaluate the evidence for recent advances and alternative approaches in electroconvulsive therapy (ECT) technique. Novel developments in ECT research are also mentioned. An EMBASE literature search was undertaken of clinical trials, case reports and research updates on novel and alternative approaches in ECT practice and research, including alternative electrode placements, variations in stimulus configuration, and novel developments (magnetic seizure therapy, focal electrical stimulation). The evidence for these approaches is reviewed, and implications for the optimizing of ECT in clinical practice are discussed. Evidence from studies suggests that unilateral ECT be given at substantially suprathreshold doses (at least 6 times seizure threshold) for maximizing efficacy, while bilateral ECT is likely to be effective at doses of 1.5-2.5 times seizure threshold. There is some evidence to support the use of bifrontal ECT, although further research is required to establish its efficacy and side-effects relative to standard unilateral and bilateral electrode placements. Other alternative electrode placements have been minimally studied. More advantageous efficacy side-effect outcomes may be achieved by reducing the pulse width and/or frequency of the ECT stimulus. Lastly, novel developments using alternative means of seizure induction (magnetic fields, focal electrical stimulation) may hold promise for the future. Clinical practice should be guided by a careful appraisal of the available evidence for alternative approaches in ECT technique.

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