1Centre Hospitalier Universitaire de Toulouse, Service universitaire de psychiatrie et psychologie médicale, Toulouse,France.
Acta Neuropsychiatr. 2019 Feb;31(1):52-55. doi: 10.1017/neu.2018.29. Epub 2018 Nov 6.
Electroconvulsive therapy (ECT) is a safe and validated technique used to treat various psychiatric conditions. It triggers an artificially-induced seizure. This seizure is defined using several parameters such as the amount of energy, duration, frequency, pulse width and intensity. Efficacy and adverse events depend on the amount of energy delivered. Due to technical control, the amount of energy delivered by our unit's ECT device was limited to 614 mC, 60% of the maximum possible output of the device. We wondered if lowering the dose would lead to better seizure quality among maintenance ECT patients.
We assessed seizure quality based on the EEG, using a validated tool created by MacPherson. Two evaluators independently rated the seizures. Pre- and post-control scores were compared using Student's t-test for paired samples.
We analysed data from 15 patients. Mean age was 65 years old. Twelve had depressive disorder, two had schizophrenia and one had schizo-affective disorder. Mean duration of seizure before control was 41.1 s [95% confidence interval (95CI)=26.1, 51.1]. The mean MacPherson's score was 20.3 (95CI=16.2, 24.4). After control, the mean MacPherson's score was 28.2 (23.1, 33.3), showing a significant difference with the pre-control dataset (p=0.032; t=-2.4; df=14). Specifically, peak mid-ictal amplitude increased from 6.9 (95CI=5.1, 8.7) to 10.0 (95CI=7.2, 12.8). Other sub-scores remained unchanged.
Lowering the energy delivered led to an overall increase of seizure quality among our sample. This highlights the necessity and utility of retitration during ECT maintenance, possibly leading to better management of our patients.
电痉挛疗法（ECT）是一种安全有效的技术，用于治疗各种精神疾病。它会引发人为诱导的癫痫发作。这种癫痫发作可以通过几个参数来定义，如能量的大小、持续时间、频率、脉冲宽度和强度。疗效和不良反应取决于所输送的能量。由于技术控制，我们单位的 ECT 设备输送的能量限制在 614mC，即设备最大输出的 60%。我们想知道降低剂量是否会导致维持性 ECT 患者的癫痫发作质量更好。
我们使用 MacPherson 创建的验证工具，根据 EEG 评估癫痫发作质量。两名评估员独立对癫痫发作进行评分。使用配对样本学生 t 检验比较控制前后的评分。
我们分析了 15 名患者的数据。平均年龄为 65 岁。12 人患有抑郁症，2 人患有精神分裂症，1 人患有分裂情感障碍。控制前癫痫发作的平均持续时间为 41.1 秒[95%置信区间（95CI）=26.1，51.1]。MacPherson 的平均得分为 20.3（95CI=16.2，24.4）。控制后，MacPherson 的平均得分为 28.2（23.1，33.3），与控制前数据集有显著差异（p=0.032；t=-2.4；df=14）。具体而言，峰中期振幅从 6.9（95CI=5.1，8.7）增加到 10.0（95CI=7.2，12.8）。其他子评分保持不变。
降低输送的能量导致我们样本中的癫痫发作质量总体提高。这突出了在 ECT 维持期间重新滴定的必要性和实用性，可能会更好地管理我们的患者。
