Francis-Taylor Rohan, Ophel Gillian, Martin Donel, Loo Colleen
School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia; Black Dog Institute, Randwick, NSW, 2031, Australia; The Wesley Hospital, Kogarah, NSW, 2217, Australia.
School of Psychiatry, University of New South Wales, Randwick, NSW, 2031, Australia.
Brain Stimul. 2020 Nov-Dec;13(6):1644-1654. doi: 10.1016/j.brs.2020.09.009. Epub 2020 Sep 28.
To provide guidance for ECT practitioners in utilising the ictal EEG to inform treatment decisions.
A systematic review of studies examining the ictal EEG, treatment technique, seizure threshold and treatment outcomes was conducted. MEDLINE, EMBASE and PsycINFO databases were searched up to July 31, 2019. Studies were included if they examined the use of ECT in human subjects and compared an ictal EEG analysis (either quantitative or manually rated) with either: a) clinical outcomes, b) seizure threshold/threshold change, c) ECT dosing decisions, or d) different aspects of ECT technique (comparison of different electrode placements, pulse widths, waveforms, or dose/dose relative to seizure threshold).
A total of 853 studies were identified, with 44 meeting inclusion criteria. A qualitative review revealed ictal EEG indices have been linked to therapeutic outcome, though the strength of this relationship appears modest. Ictal EEG features are influenced by variations in ECT treatment technique. Serial ictal EEG monitoring can detect changes in seizure threshold across an ECT course for right unilateral brief and ultrabrief pulse ECT.
While there is some relationship between ictal EEG manifestation and treatment outcomes, the primary utility of ictal EEG monitoring during an ECT course may lie in the capacity to detect changes in seizure threshold and adjust dosing accordingly. Prospective validation of a dosing regime informed by serial ictal EEG monitoring is warranted.
为电休克治疗（ECT）从业者利用发作期脑电图来指导治疗决策提供指导。
对研究发作期脑电图、治疗技术、癫痫阈值和治疗结果的研究进行系统综述。检索截至2019年7月31日的MEDLINE、EMBASE和PsycINFO数据库。如果研究考察了ECT在人类受试者中的应用，并将发作期脑电图分析（定量或人工评分）与以下内容进行比较，则纳入研究：a）临床结果，b）癫痫阈值/阈值变化，c）ECT剂量决策，或d）ECT技术的不同方面（不同电极放置、脉冲宽度（脉宽）、波形或相对于癫痫阈值的剂量/剂量比较）。
共识别出853项研究，其中44项符合纳入标准。定性综述显示，发作期脑电图指标与治疗结果有关，尽管这种关系的强度似乎不大。发作期脑电图特征受ECT治疗技术变化的影响。连续发作期脑电图监测可以检测右侧单侧短暂和超短脉冲ECT整个疗程中癫痫阈值的变化。
虽然发作期脑电图表现与治疗结果之间存在一定关系，但在ECT疗程中发作期脑电图监测的主要作用可能在于检测癫痫阈值的变化并相应调整剂量。有必要对基于连续发作期脑电图监测的给药方案进行前瞻性验证。
