Kayser Sarah, Bewernick Bettina H, Soehle Martin, Switala Christina, Gippert Sabrina M, Dreimueller Nadine, Schlaepfer Thomas E
From the Departments of *Psychiatry and Psychotherapy, and †Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn; ‡Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany; and §Departments of Psychiatry and Behavioral Sciences, The Johns Hopkins University, Baltimore, MD.
J ECT. 2017 Sep;33(3):167-175. doi: 10.1097/YCT.0000000000000425.
Anesthesia is required for both magnetic seizure therapy (MST) and electroconvulsive therapy (ECT), although it has anticonvulsant properties. In this case, bispectral index (BIS) monitoring, a specific electroencephalogram-derived monitoring, can be used to find the optimal seizure induction time during anesthesia to elicit adequate seizures. A measurement of seizure adequacy in electroencephalogram is the postictal suppression. The purpose of this study was to investigate the influence of seizure induction time on the degree of postictal suppression by comparing BIS versus no-BIS monitoring in MST and ECT.
Twenty patients with treatment-resistant depression were randomly assigned to either MST or ECT. Each patient underwent 3 treatments with the determination of seizure induction time by defined prestimulation BIS (BIS condition) and 3 treatments with determination of seizure induction time by controlled clinical trial protocol (no-BIS condition). Statistical analysis was calculated by repeated-measures analysis of variance.
The degree of postictal suppression was more pronounced in both MST and ECT, with BIS monitoring. In this connection, no differences between MST and ECT were found. Seizure induction time was significantly later in the BIS condition (181.3 ± 6 seconds) compared with the no-BIS condition (114.3 ± 12 seconds) (P < 0.001).
Adequacy of seizures, in the form of the degree of postictal suppression, was superior by determining the seizure induction time with BIS in both MST and ECT. Further research is needed to investigate the correlation between the degree of postictal suppression and treatment response.
尽管麻醉具有抗惊厥特性，但磁休克治疗（MST）和电休克治疗（ECT）都需要麻醉。在这种情况下，脑电双频指数（BIS）监测，一种特定的脑电图衍生监测方法，可用于在麻醉期间找到最佳的癫痫发作诱导时间以引发足够的癫痫发作。脑电图中癫痫发作充分性的一个衡量指标是发作后抑制。本研究的目的是通过比较MST和ECT中BIS监测与非BIS监测，探讨癫痫发作诱导时间对发作后抑制程度的影响。
20例难治性抑郁症患者被随机分配接受MST或ECT治疗。每位患者接受3次治疗，通过定义的预刺激BIS确定癫痫发作诱导时间（BIS组），以及3次通过对照临床试验方案确定癫痫发作诱导时间的治疗（非BIS组）。采用重复测量方差分析进行统计分析。
在MST和ECT中，采用BIS监测时发作后抑制程度更为明显。在这方面，未发现MST和ECT之间存在差异。与非BIS组（114.3±12秒）相比，BIS组的癫痫发作诱导时间显著更晚（181.3±6秒）（P<0.001）。
在MST和ECT中，通过BIS确定癫痫发作诱导时间，以发作后抑制程度形式表现的癫痫发作充分性更佳。需要进一步研究来探讨发作后抑制程度与治疗反应之间的相关性。
