Effects of stimulus parameters on motor seizure duration in electroconvulsive therapy

Abstract

Sung Woo Joo, Yeon Ho Joo, Chang Yoon Kim, Jung Sun Lee Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea Objective: This study examined the effect of stimulus parameters on the occurrence of adequate seizures and reconsidered the factors related to motor seizure duration.Methods: The medical records of 187 patients who received ECT in Asan Medical Center from January 2007 to May 2014 were retrospectively reviewed. The starting stimulus dose was determined using a preselected-dose method and the cutoff value to determine the adequate motor seizure duration was 20–25 seconds. The association between seizure parameters and the occurrence of adequate seizure was assessed with logistic regression using a generalized estimating equation.Results: Age (P<0.001), use of mood stabilizers (P=0.002), and benzodiazepine (P<0.001) were significantly lower in sessions with an adequate seizure duration but use of antidepressants (P<0.001) and clozapine (P=0.025) were significantly higher in sessions with an adequate seizure duration. In the generalized estimating equation analyses, after adjustment for age, benzodiazepine dose, and lamotrigine use, charge (odds ratio [OR] =0.999; 95% confidence interval [CI], 0.998–1.000; P=0.005), and train duration (OR =0.632; 95% CI, 0.490–0.817; P<0.001) were significantly associated with the occurrence of adequate seizure.Discussion: Stimulus charge and train duration are significantly associated with motor seizure duration. However, train duration appears to have a greater effect on motor seizure duration. Additionally, age, benzodiazepine dose, and lamotrigine use independently affect motor seizure duration. Keywords: electroconvulsive therapy, seizure duration, seizure parameter, age, lamotrigine, benzodiazepine

Keywords

• electroconvulsive therapy
• seizure parameters
• seizure duration