Verònica Gálvez1, Dusan Hadzi-Pavlovic1, Deidre Smith2, Colleen K Loo3. 1. School of Psychiatry, University of New South Wales (UNSW), Hospital Road, 2031, Randwick, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, 2031, Randwick, Sydney, NSW Australia. 2. The Melbourne Clinic & Department of Psychiatry, University of Melbourne, Grattan St Parkville 3010, Melbourne, VIC, Australia. 3. School of Psychiatry, University of New South Wales (UNSW), Hospital Road, 2031, Randwick, Sydney, NSW, Australia; Black Dog Institute, Hospital Road, 2031, Randwick, Sydney, NSW Australia; Department of Psychiatry, St George Hospital, Level 2, James Laws House, Gray St, Kogarah 2217, Sydney, NSW, Australia. Electronic address: colleen.loo@unsw.edu.au.
Abstract
BACKGROUND: An individualized approach to maximize electroconvulsive therapy (ECT) efficacy and minimize cognitive side effects is to treat patients relative to their seizure threshold (ST). However, although Right Unilateral-Ultrabrief (0.3 ms) (RUL-UB) ECT is increasingly used in clinical settings as an effective form of ECT with minimal cognitive effects, there is sparse data regarding predictors of ST. OBJECTIVE: To analyze the relationship between ST and clinical and demographic factors in a sample of patients treated with RUL-UB ECT. METHODS: Clinical, demographic and ECT data from 179 patients in ECT research studies were examined. Seizure threshold was titrated at the first ECT session. ECT was performed with a Thymatron(®) or Mecta(®) device, with thiopentone (2.5-5 mg/kg) or propofol (1-2 mg/kg) anaesthesia. Medications taken at the time of ST titration were documented. The association between ST and candidate predictor variables was examined with regression analysis. RESULTS: Multiple regression analyses showed that 34% of the variance in ST (P < 0.001) could be predicted. Older age (R(2) = 0.194, P < 0.001), propofol (vs thiopentone) (R(2) = 0.029, P ≤ 0.01) and higher anaesthetic dose (mg in propofol equivalents) (R(2) = 0.029, P < 0.05) were found to be predictors of higher initial ST. Treatment with lithium (R(2) = 0.043, P < 0.01) and study site (R(2) = 0.019, P < 0.05) significantly predicted lower initial ST. CONCLUSIONS: Empirical titration is recommended for accurate determination of ST in patients receiving RUL-UB ECT. Novel findings of this study are that propofol anaesthesia resulted in higher ST than thiopentone and concomitant treatment with lithium treatment lowered ST.
BACKGROUND: An individualized approach to maximize electroconvulsive therapy (ECT) efficacy and minimize cognitive side effects is to treat patients relative to their seizure threshold (ST). However, although Right Unilateral-Ultrabrief (0.3 ms) (RUL-UB) ECT is increasingly used in clinical settings as an effective form of ECT with minimal cognitive effects, there is sparse data regarding predictors of ST. OBJECTIVE: To analyze the relationship between ST and clinical and demographic factors in a sample of patients treated with RUL-UB ECT. METHODS: Clinical, demographic and ECT data from 179 patients in ECT research studies were examined. Seizure threshold was titrated at the first ECT session. ECT was performed with a Thymatron(®) or Mecta(®) device, with thiopentone (2.5-5 mg/kg) or propofol (1-2 mg/kg) anaesthesia. Medications taken at the time of ST titration were documented. The association between ST and candidate predictor variables was examined with regression analysis. RESULTS: Multiple regression analyses showed that 34% of the variance in ST (P < 0.001) could be predicted. Older age (R(2) = 0.194, P < 0.001), propofol (vs thiopentone) (R(2) = 0.029, P ≤ 0.01) and higher anaesthetic dose (mg in propofol equivalents) (R(2) = 0.029, P < 0.05) were found to be predictors of higher initial ST. Treatment with lithium (R(2) = 0.043, P < 0.01) and study site (R(2) = 0.019, P < 0.05) significantly predicted lower initial ST. CONCLUSIONS: Empirical titration is recommended for accurate determination of ST in patients receiving RUL-UB ECT. Novel findings of this study are that propofol anaesthesia resulted in higher ST than thiopentone and concomitant treatment with lithium treatment lowered ST.
Authors: Takahiro Soda; Declan M McLoughlin; Scott R Clark; Leif Oltedal; Ute Kessler; Jan Haavik; Chad Bousman; Daniel J Smith; Miquel Bioque; Caitlin C Clements; Colleen Loo; Fidel Vila-Rodriguez; Alessandra Minelli; Brian J Mickey; Roumen Milev; Anna R Docherty; Julie Langan Martin; Eric D Achtyes; Volker Arolt; Ronny Redlich; Udo Dannlowski; Narcis Cardoner; Emily Clare; Nick Craddock; Arianna Di Florio; Monika Dmitrzak-Weglarz; Liz Forty; Katherine Gordon-Smith; Mustafa Husain; Wendy M Ingram; Lisa Jones; Ian Jones; Mario Juruena; George Kirov; Mikael Landén; Daniel J Müller; Axel Nordensköld; Erik Pålsson; Meethu Paul; Agnieszka Permoda; Bartlomiej Pliszka; Jamie Rea; Klaus O Schubert; Joshua A Sonnen; Virginia Soria; Will Stageman; Akihiro Takamiya; Mikel Urretavizacaya; Stuart Watson; Maxim Zavorotny; Allan H Young; Eduard Vieta; Janusz K Rybakowski; Massimo Gennarelli; Peter P Zandi; Patrick F Sullivan; Bernhard T Baune Journal: Eur Arch Psychiatry Clin Neurosci Date: 2019-12-04 Impact factor: 5.270
Authors: Gregory L Sahlem; William V McCall; E Baron Short; Peter B Rosenquist; James B Fox; Nagy A Youssef; Andrew J Manett; Suzanne E Kerns; Morgan M Dancy; Laryssa McCloud; Mark S George; Harold A Sackeim Journal: Brain Stimul Date: 2020-07-29 Impact factor: 8.955