From the Departments of Psychiatry and Psychotherapy.
Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
J ECT. 2021 Dec 1;37(4):247-249. doi: 10.1097/YCT.0000000000000781.
A burst suppression pattern in the electroencephalogram represents a down-regulated brain state, which also occurs in the postictal phase of electroconvulsive therapy (ECT). Suppressive actions of the brain to terminate the seizure are thought to be necessary for the efficacy of ECT. On the other hand, recent studies showed an association of burst suppression in general anesthesia or sedation with (postprocedural) cognitive complications.
We retrospectively examined the length of postictal burst suppression and reorientation time in 49 ECT sessions of 25 consecutive patients. Burst suppression duration was determined by bispectral index monitoring and defined as the time with a bispectral index value of less than 20%. The association between duration of burst suppression and reorientation time was analyzed with multivariate logistic and linear regression analysis controlling for several covariates.
The reorientation time showed a statistically significant association with the duration of burst suppression, but with no other variable. Longer phase of postictal burst suppression predicted longer reorientation time in the recovery room (P = 0.046).
The association between the duration of postictal burst suppression and reorientation time after ECT in this sample suggests that (not only the efficacy but also the) cognitive adverse effects of ECT might be related to the extent of postictal central inhibition after the termination of the seizure.
脑电图中的爆发抑制模式代表大脑调节降低的状态，这种状态也会出现在电抽搐治疗（ECT）的癫痫发作后期。人们认为大脑抑制癫痫发作的作用对于 ECT 的疗效是必要的。另一方面，最近的研究表明，全身麻醉或镇静时的爆发抑制与（术后）认知并发症有关。
我们回顾性地检查了 25 名连续患者的 49 次 ECT 疗程中癫痫发作后期爆发抑制和定向时间的长度。爆发抑制持续时间通过双频谱指数监测确定，并定义为双频谱指数值小于 20%的时间。使用多元逻辑回归和线性回归分析，控制了几个协变量，分析了爆发抑制持续时间和定向时间之间的关联。
定向时间与爆发抑制持续时间呈统计学显著关联，但与其他变量无关。癫痫发作后期爆发抑制持续时间较长预测恢复室定向时间较长（P = 0.046）。
本样本中癫痫发作后期爆发抑制持续时间与 ECT 后定向时间之间的关联表明，（不仅是疗效，而且是）ECT 的认知不良影响可能与癫痫发作终止后中枢抑制的程度有关。
