Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore 539747, Singapore.
Asian J Psychiatr. 2021 Dec;66:102874. doi: 10.1016/j.ajp.2021.102874. Epub 2021 Sep 29.
Available literature remains limited in the identification of risk factors for prolonged seizures in electroconvulsive therapy and much less is reported about the continuation of electroconvulsive therapy after prolonged seizures. We describe two cases with prolonged seizures early in their course of electroconvulsive therapy and the subsequent adjustment made that allowed for safe and effective continuation of electroconvulsive therapy. In both cases, right unilateral electroconvulsive therapy was continued at a suprathreshold stimulus dose of six times relative to seizure threshold. Both patients continued their course of electroconvulsive therapy with no further episodes of prolonged seizures. They did not experience significant cognitive side effects and were discharged after showing marked improvement in their clinical symptoms. Prolonged seizures do not preclude the use of electroconvulsive therapy. The selection of ultrabrief right unilateral electroconvulsive therapy allows for a higher suprathreshold dose with less cognitive side effects compared to bilateral placements. This mitigates the risk of prolonged seizures, allowing for safe and effective continuation of electroconvulsive therapy.
现有文献在识别电抽搐治疗中癫痫持续时间延长的危险因素方面仍然有限，关于癫痫持续时间延长后继续电抽搐治疗的报道则更少。我们描述了两例电抽搐治疗早期癫痫持续时间延长的病例，以及随后进行的调整，从而能够安全有效地继续电抽搐治疗。在这两种情况下，右单侧电抽搐治疗均以相对于癫痫发作阈值的六倍超阈值刺激剂量继续进行。两名患者均继续进行电抽搐治疗，未再出现癫痫持续时间延长的情况。他们没有经历明显的认知副作用，在临床症状明显改善后出院。癫痫持续时间延长并不排除电抽搐治疗的使用。与双侧放置相比，选择超短右单侧电抽搐治疗可使用更高的超阈值剂量，且认知副作用更小。这降低了癫痫持续时间延长的风险，从而能够安全有效地继续电抽搐治疗。
