Key result
Higher age and bifrontotemporal electrode placement independently predicted a higher initial seizure threshold and higher seizure threshold levels during the course of electroconvulsive therapy.
Why the study?
What are the clinical predictors of initial seizure threshold and its changes during electroconvulsive therapy in adult patients?
Observational (n=91)
No
What are the clinical predictors of initial seizure threshold and its changes during electroconvulsive therapy in adult patients?
Effect estimate: b = 0.42 (for bifrontotemporal electrode placement)
p-value: p=<0.001
Increasing age and bifrontotemporal electrode placement predict higher initial seizure thresholds in patients undergoing ECT, which should inform dosage selection.
Higher age and bilateral placement were associated with elevated seizure thresholds in ECT; leaves open whether these predictors warrant adjusted dosing protocols.
At the start and during the course of electroconvulsive therapy (ECT), estimation of the seizure threshold (ST) is useful in weighing the expected effectiveness against the risks of side effects. Therefore, this study explores clinical factors predicting initial ST (IST) and levels of ST during the ECT course. This prospective observational study included patients aged ≥18 years receiving ECT without contraindications for dose titration. At the first and every sixth consecutive ECT session, ST level was measured. Using multivariate linear regression and multilevel models, predictors for IST and change in ST levels were examined. A total of 91 patients (mean age, 59.1 ± 15.0 years; 37 % male; 97 % diagnosis of depression) were included. In multivariable analysis, higher age (β = 0.24; P = 0.03) and bifrontotemporal (BL) electrode placement (β = 0.42; P < 0.001) were independent predictors for higher IST, explaining 49 % of its variation. Also, these two variables independently predicted higher ST levels at different time points during the course. Using multilevel models, absence of a previous ECT course(s) predicted a steeper rise in ST during the course (P = 0.03 for the interaction term time*previous ECT). The age-adjusted dose-titration method is somewhat crude, resulting in some measurement error. Concomitant medication use could have influenced ST levels. Increasing age and BL electrode placement predicted higher (I)ST, which should be taken into account when selecting ECT dosage. Previous ECT course(s) may avoid an increase in ST during the course of ECT.
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Waarde et al. (2012) conducted an observational in Depression (indication for electroconvulsive therapy) (n=91). Clinical predictors (age, electrode placement, previous ECT) was evaluated on Initial seizure threshold (IST) (b = 0.42 (for bifrontotemporal electrode placement), p=<0.001). Higher age and bifrontotemporal electrode placement independently predicted a higher initial seizure threshold and higher seizure threshold levels during the course of electroconvulsive therapy.
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