Relationships between seizure duration and seizure threshold and stimulus dosage at electroconvulsive therapy: Implications for electroconvulsive therapy practice
Relationships between seizure duration and seizure threshold and stimulus dosage at electroconvulsive therapy: Implications for electroconvulsive therapy practice
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DOI：
10.1046/j.1440-1819.2002.01048.x
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发表时间：
2002-10-01
影响因子：
11.9
通讯作者：
Chung, KF
中科院分区：
文献类型：
--
作者：
Chung, KF
最近的研究质疑癫痫发作持续时间作为电休克治疗（ECT）刺激剂量调整指标的有效性。回顾性分析54例接受标准化ECT剂量滴定和治疗方案的患者的癫痫发作持续时间与癫痫发作阈值和刺激剂量之间的关系。在癫痫发作阈值接受刺激剂量的受试者具有高度可变的运动性癫痫发作持续时间，范围为15至89 s，7.4%的受试者癫痫发作时间超过60 s。回归分析表明，初始癫痫发作阈值和身高是剂量滴定期间运动性癫痫发作持续时间的独立预测因子，占其方差的34%。在第一次和第二次ECT治疗之间，刺激剂量增加了40-67%;然而，60%的受试者在第二次治疗时癫痫发作没有延长，运动性癫痫发作持续时间显著缩短（平均值+/- SD：35.7 +/- 12.3 vs 31.0 +/- 10.6 s;配对t = 2.9，d.f. = 34，P = 0.006）。在第一次和第二次ECT治疗时，运动性癫痫发作持续时间与刺激剂量显着相关（分别为r = -0.45和r =-0.41）。鉴于癫痫发作持续时间和刺激强度之间的负相关性，建议增加刺激剂量和减少短期和长期癫痫发作患者的刺激剂量的政策，并不一定会导致“最佳”癫痫发作持续时间。提出了一种更好的给药政策，不太强调癫痫发作持续时间。
Recent studies cast doubt on the usefulness of seizure duration as an index for stimulus dosage adjustment at electroconvulsive therapy (ECT). A retrospective analysis on the relationships between seizure duration and seizure threshold and stimulus dosage was performed for 54 patients who received a standardized ECT dose titration and treatment protocol. Subjects receiving stimulus dosage at seizure threshold had a highly variable motor seizure duration, ranging from 15 to 89 s, and 7.4% of subjects had seizures longer than 60 s. Regression analysis showed that initial seizure threshold and height were independent predictors of motor seizure duration during dose titration and accounted for 34% of its variance. Stimulus dosage was increased by 40-67% between the first and second ECT session; however, 60% of subjects had no lengthening of seizures and motor seizure duration was significantly shorter at the second treatment (mean +/- SD: 35.7 +/- 12.3 vs 31.0 +/- 10.6 s; paired t = 2.9, d.f. = 34, P = 0.006). At the first and second ECT treatment, motor seizure duration was significantly related to stimulus dosage (r = -0.45 and r = -0.41, respectively). Given the negative correlation between seizure duration and stimulus intensity, a policy that recommends an increase of stimulus dosage and its reduction for patients with short and long seizures, respectively, does not necessarily result in 'optimal' seizure duration. A better dosing policy that places less emphasis on seizure duration is proposed.