ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Titration of the electroconvulsive therapy (ECT) stimulus to the patient's convulsive threshold is the only way to directly assess the patient's seizure threshold. This technique is presently practiced by 39% of ECT providers, according to a recent survey. Because multiple variables influence the seizure threshold in patients, multivariate statistical methods may provide a useful strategy to determine which variables exert the most influence on convulsive threshold. A multivariate ordinal logistic model of seizure threshold was developed on an experimental group of 66 consecutive patients undergoing titrated right unilateral (RUL) ECT for major depression. The accuracy of the model was cross-validated on a second group of 40 patients undergoing similar RUL ECT procedures. The final multivariate ordinal logistic regression model for the seizure threshold level (STL) was significant (Likelihood ratio χ2= 54.115; p < 0.0001:R2= 0.313). Increasing age, African-American race, and longer inionnasion distances (p < 0.06) predicted higher STL. Female gender was associated with a lower STL. The ability of the final model to accurately predict STL for the validation group was fair (pairwise correlation was 0.576; p < 0.001). The model did well for predicting lower STL, but fared poorly for higher STL. In conclusion, modeling STL may help establish the relative contribution of variables thought to be important to seizure threshold. However, STL models remain impractical for clinical applications in estimating seizure threshold at this time, and empirical stimulus titration should be used.

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Ictal EEG indices show promise for separating individual ECT seizures on the basis of treatment electrode placement (ELPL), relative stimulus intensity (Dose), and expected therapeutic response. One factor impeding the effective clinical implementation of ictal EEG indices for these purposes is uncertainty as to the relative utility of lower and higher frequency EEG activity. Recent articles are contradictory in this regard, but no data exist addressing this issue. As a result, we reanalyzed data from 44 subjects in two studies and compared the relative ability of ictal EEG data in three frequency bands to differentiate seizures as a function of ELPL, Dose, and therapeutic response. We found that the frequency band that best differentiated these groups depended on the EEG measure used, the temporal portion of the seizure, and whether ELPL, Dose, or therapeutic response was being compared.

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Three electroconvulsive therapy (ECT) stimuli of increasing dosage were applied sequentially under one anesthesia to each of two patients. With each, the first produced intense electroencephalogram (EEG) seizure activity with a sharp endpoint but no motoric activity and little heart rate elevation. The second produced 15–21 s of tonic-clonic activity with negligible seizure activity on the EEG monitor and little heart rate increase. The third produced typical motoric, EEG, and heart rate signs of seizure. These observations indicate that the signs of high EEG amplitude, sharp EEG endpoint, distinct postictal suppression, and tonic-clonic activity can appear in seizures of questionable quality and weak generalization through the brain. Consequently, none of these characteristics by themselves indicate good quality or seizure generalization, and ECT monitoring is incomplete without considering all of them along with peak heart rate.

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Catatonic syndromes are seen in diverse psychiatric and systemic illnesses, and may have varied presentations. Although reports suggest that benzodiazepines are helpful, debate persists regarding definitive treatment for catatonia. We present a case in which electroconvulsive therapy effectively resolved symptoms in an adolescent patient with catatonia who had only a transient response to lorazepam.

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0749-8055    

出版商:OVID    

年代:1996

数据来源: OVID