Incidence Of Prolonged Motor And Eeg Seizures In Electroconvulsive Therapy : A 1 Year Cross-Sectional Hospital Based Study

Abstract

Introduction: Electroconvulsive Therapy has been an effective therapeutic option for psychiatric illnesses. The practice of ECT has evolved over the decades to make it more safer and efficacious by the use of anesthetic agents, muscle relaxants, modifying electric stimulus parameters, electrode placement sites, adjusting concurrent medications etc. Higher rates of adverse effects in ECT are noted with prolonged seizures and status epilepticus. Detecting these by just motor method is unreliable and additional EEG monitoring method has been considered to be a better option. Aims: To find the incidence rate of prolonged seizures in patients undergoing ECTs and its associated factors like EEG monitoring and ECT session number. Materials and methods: 216 sessions in patients undergoing modified ECT for various psychiatric diagnoses were included in this cross-sectional study. Patient characteristics and seizure characteristics were noted after seizure was induced by electric current stimulus from the ECT apparatus with EEG. Seizures were noted as per motor and EEG characteristics defined by Royal College of Psychiatrists ,UK (2005). Results: 24 were Prolonged seizures, 149 were Adequate seizures. The remaining 33 were missed or inadequate seizures. 9 (37.5%) of these 24 prolonged seizures were detected exclusively by the use of EEG monitoring. Prolonged seizures were significantly higher in First and second ECT sessions, compared to later sessions. 10 (6.7%) of the 149 adequate seizures were picked up exclusively by EEG monitoring. There were no significant association of prolonged seizures with gender, BMI, sub-types of psychosis, concurrent use of lithium or clozapine in ECTs. Conclusion: EEG monitoring during modified ECT helps in detecting prolonged and adequate seizures which may have otherwise been missed by using only motor criteria. Prolonged seizures were significantly associated with ECT sessions and was higher with the first ECT than second and later ECT sessions.