Zucker Hillside Hospital, Northshore-Long Island Jewish Health System Glen Oaks, NY 11004, USA.
J ECT. 2009 Dec;25(4):232-7. doi: 10.1097/yct.0b013e31819c76ff.
We sought to examine the relationship of seizure threshold (ST) to age and other demographic characteristics in a large sample where ST was determined by the dose titration (DT) method. We also compared the resulting stimulation levels to estimates predicted by an age-based formula, the half-age (HA) method.
In a multicenter prospective study, patients received a standardized course of bilateral electroconvulsive therapy for major depression using a brief pulse device. The ST was determined at the first treatment using a fixed algorithm of stimulations. Subsequent seizures were induced at a level 50% higher than the empirically determined ST. We only included data from subjects receiving methohexital anesthesia. We correlated ST with demographic and clinical characteristics of the sample. The actual dosing levels at the second treatment were compared with estimates based on HA.
Of the original 531 subjects, 402 met criteria for the current analysis. The ST was positively correlated with age. Male patients had slightly higher ST than female patients. Neither race, severity of illness, psychosis, nor use of psychotropic medications affected ST. Little variability in titrated ST was observed among our patients. An ST of 40 ("percent of charge") or lower was found in 97.5% of patients, with either 20 or 40 in 80% of patients. Ninety-six percent of the patients were treated at the 3 levels of 15%, 30%, or 60%. Estimated HA stimulus levels offered a wider range of choices compared with this particular algorithm used for ST determination at an average level of 18% above the determined ST.
Seizure threshold correlates strongly with age, whereas there is a weaker relation between ST and sex. There was little individual variation of ST determined by the DT method among subjects, possibly because of the wide spacing between steps of this particular titration algorithm. Half-age estimates were 18% above the empirically determined ST. This suggests that the use of the HA estimates at the first treatment may result in fewer stimulations compared with the DT method.
我们试图在一个大样本中通过剂量滴定（DT）方法来检验癫痫发作阈值（ST）与年龄和其他人口统计学特征之间的关系。我们还将比较由此产生的刺激水平与基于年龄的公式（半龄（HA）方法）的预测值。
在一项多中心前瞻性研究中，患者使用短脉冲装置接受了针对重度抑郁症的双侧电惊厥治疗的标准疗程。使用固定的刺激算法在第一次治疗时确定 ST。随后的癫痫发作在比经验确定的 ST 高 50%的水平上诱导。我们只包括接受甲己炔巴比妥麻醉的受试者的数据。我们将 ST 与样本的人口统计学和临床特征相关联。将第二次治疗的实际剂量水平与基于 HA 的估计值进行比较。
在最初的 531 名受试者中，有 402 名符合当前分析的标准。ST 与年龄呈正相关。男性患者的 ST 略高于女性患者。种族、疾病严重程度、精神病或使用精神药物均不影响 ST。我们的患者中观察到的滴定 ST 变异性很小。97.5%的患者 ST 为 40（“电荷百分比”）或更低，80%的患者 ST 为 20 或 40。96%的患者接受了 15%、30%或 60%的 3 个水平的治疗。与用于确定 ST 的特定算法相比，HA 刺激水平提供了更广泛的选择范围，平均比确定的 ST 高 18%。
癫痫发作阈值与年龄密切相关，而 ST 与性别之间的关系较弱。通过 DT 方法确定的 ST 在受试者中个体差异较小，这可能是由于该特定滴定算法的步长之间的间隔较宽。HA 估计值比经验确定的 ST 高 18%。这表明与 DT 方法相比，在第一次治疗时使用 HA 估计值可能会减少刺激次数。
