M.S. JAYAPRAKASH, M.D., Senior Resident, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore -560 029.
Indian J Psychiatry. 1998 Jan;40(1):55-9.
Seizures were monitored using both cuff method and EEG, during the first ECT session in 158 consecutive patients. All developed adequate EEG seizures (≥25 seconds). Twelve patients (8%) did not develop adequate motor seizures (15 seconds), of whom ten had no convulsive response. EEG seizure duration was less than 120 seconds in 117 patients (Group-A) and 120 or more seconds (prolonged) in the remaining 37 patients (Group-B). Adequate but not prolonged motor seizure (15-89 seconds) occurred in 111 patients in group A and 18 patients in group B. Motor seizure of 90 or more seconds (prolonged seizure) occurred in four patients in group A and 13 patients in group B. Based on the motor seizure criterion, 60% (18/31) of patients with prolonged EEG seizure were missed. The motor and EEG seizure durations correlated significantly in both groups. The correlation coefficient in group A was 0.78 (p< 0.01), which was significantly larger (Fisher's 'Z' transformation test, t=3.12, p< 0.01) than that in group B (0.37; p< 0.05). Out of the total 158 patients, motor seizure monitoring alone did not correctly classify 21.4% of ECT seizure. This could have resulted in either unnecessary re-stimulation or failure to detect prolonged seizure. The findings suggest that in ECT motor seizure monitoring alone is unsatisfactory and therefore the need for EEG seizure monitoring.
在 158 例连续患者的首次 ECT 治疗中，使用袖带法和 EEG 监测癫痫发作。所有患者均出现足够的 EEG 癫痫发作（≥25 秒）。12 名患者（8％）未出现足够的运动性癫痫发作（15 秒），其中 10 名患者无抽搐反应。117 例患者（A 组）的 EEG 癫痫持续时间小于 120 秒，其余 37 例（B 组）持续 120 秒或更长时间。A 组中有 111 例患者出现足够但不延长的运动性癫痫发作（15-89 秒），B 组中有 18 例患者出现足够但不延长的运动性癫痫发作。A 组中有 4 例患者出现持续 90 秒或更长时间的运动性癫痫发作（持续癫痫发作），B 组中有 13 例患者出现持续 90 秒或更长时间的运动性癫痫发作。根据运动性癫痫发作标准，60％（18/31）的延长 EEG 癫痫发作患者未被发现。两组的运动性和 EEG 癫痫发作持续时间均呈显著相关性。A 组的相关系数为 0.78（p<0.01），明显大于 B 组（0.37；Fisher's 'Z' 转换检验，t=3.12，p<0.01）。在总共 158 例患者中，单独进行运动性癫痫发作监测未能正确分类 21.4％的 ECT 癫痫发作。这可能导致不必要的再刺激或未能检测到持续癫痫发作。研究结果表明，在 ECT 中，单独进行运动性癫痫发作监测并不令人满意，因此需要进行 EEG 癫痫发作监测。
