Mayur P M, Gangadhar B N, Janakiramaiah N, Subbakrishna D K
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
Br J Psychiatry. 1999 Mar;174:270-2. doi: 10.1192/bjp.174.3.270.
The occurrence of a seizure during electroconvulsive therapy (ECT) should be confirmed. Most clinicians use motor seizure monitoring alone and recent guidelines have not considered electroencephalogram (EEG) monitoring mandatory.
To examine the potential pitfalls of motor seizure monitoring.
Consenting consecutive patients (n = 232) were prospectively studied at the first ECT session using both motor and EEG seizure monitoring. It was ensured (by titration) that all the patients had an adequate EEG seizure. Adequate and prolonged seizures were defined according to the latest recommendations of the Royal College of Psychiatrists.
Motor seizure was inadequate in 15 (7%) of patients. EEG seizure was prolonged in 38 (16%) of patients. Fifteen patients (39%) did not have a prolonged motor seizure. Motor seizure correlated well (r = 0.8, P < 0.001) with EEG seizure when the latter was adequate, but not when prolonged (r = 0.12, P > 0.5).
Motor seizure monitoring without EEG is undependable. The study provides a rational basis for the Royal College of Psychiatrists' definition of prolonged EEG seizure.
电休克治疗（ECT）期间癫痫发作的发生应得到确认。大多数临床医生仅使用运动性癫痫监测，且近期指南未将脑电图（EEG）监测视为必需。
探讨运动性癫痫监测的潜在缺陷。
前瞻性研究连续入选的232例患者，在首次ECT治疗时同时使用运动性癫痫和EEG癫痫监测。通过滴定确保所有患者有足够的EEG癫痫发作。根据皇家精神科医学院的最新建议定义足够且持续时间长的癫痫发作。
15例（7%）患者运动性癫痫发作不足。38例（16%）患者EEG癫痫发作持续时间长。15例患者（39%）没有持续时间长的运动性癫痫发作。当EEG癫痫发作足够时，运动性癫痫发作与之相关性良好（r = 0.8，P < 0.001），但当持续时间长时则不然（r = 0.12，P > 0.5）。
不进行EEG监测的运动性癫痫监测不可靠。该研究为皇家精神科医学院对EEG癫痫发作持续时间长的定义提供了合理依据。
