Key result
Switching to a 'long' brief pulse width of 1.5 ms during electroconvulsive therapy successfully induced effective seizures in five of six patients who were unresponsive to standard brief pulse ECT.
Why the study?
In patients with high seizure thresholds undergoing electroconvulsive therapy, augmentation strategies are needed when standard brief pulse therapy does not induce effective seizures.
Does 'long' brief pulse ECT (1.5 ms) induce effective seizures in patients with high seizure thresholds unresponsive to standard brief pulse ECT?
Case Report (n=6)
No
Does 'long' brief pulse ECT (1.5 ms) induce effective seizures in patients with high seizure thresholds unresponsive to standard brief pulse ECT?
Lengthening the pulse width to 1.5 ms in ECT may be a promising option for patients with high seizure thresholds who fail to achieve effective seizures with standard brief pulse ECT.
May enable seizure induction in high-threshold cases unresponsive to standard methods; leaves open need for controlled trials.
Electroconvulsive therapy (ECT) has been used as an effective treatment modality for psychiatric disorders. In patients with high seizure thresholds, augmentation strategies are considered such as changing anesthetic agents, hyperventilation, and premedication with theophylline. We tried to switch to "long (1.5 ms)" brief pulse ECT in all six patients from October 2020. The successful induction of effective seizures with "long" brief pulse stimulation in five of six patients who could not be treated adequately with standard ECT. In the current situation in cases in which brief pulse ECT, with the maximum dose did not lead to effective seizures, "long" brief pulse waves may be a promising option.
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Katagai et al. (2021) conducted a case report in Treatment-resistant schizophrenia or major depressive disorder with high seizure threshold (n=6). "Long" brief pulse ECT vs. Standard brief pulse ECT (0.25 or 0.5 ms pulse width) was evaluated on Successful induction of effective seizures. Switching to a 'long' brief pulse width of 1.5 ms during electroconvulsive therapy successfully induced effective seizures in five of six patients who were unresponsive to standard brief pulse ECT.
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