Skip to main content
Log in

The ictal electroencephalogram as a marker for the efficacy of electroconvulsive therapy

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

The question of how to define a therapeutically adequate electroconvulsive therapy (ECT) has been under discussion since the early days of ECT. Although convention has asserted a demand for minimum seizure times, the complex electrophysiological conditions involved in developing a generalized seisure make it problematic for therapeutic efficacy of ECT to be linked only with seizure duration. Within the framework of an open clinical study of 40 patients, selected parameters of the ictal electroencephalogram (EEG) have now been examined with respect to differentiation between therapeutically effective and ineffective treatments. For this purpose a rating scale covering both quantitative and qualitative features of the ictal EEG was used. Although this study recorded no correlations between seizure duration and clinical improvement, correlations were established between clinical improvement, on the one hand, and the frequency of epileptic discharges and their slowing during the spike-wave phase as well as the stereotypy of the discharge or a “stable” pattern of rhythmic spike-wave or sharp wave complexes, on the other. The results suggest that several of these EEG parameters might be combined to form a marker for therapeutically adequate ECT, and that treatment might be controlled accordingly.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abrams R (1992) Electroconvulsive therapy, 2nd edn, Oxford University Press, Oxford New York Tokyo

    Google Scholar 

  • Antrop S (1941) Electric shock therapy in the psychoses: convulsive and subconvulsive methods. Psychiatr Q 16:730–749

    Google Scholar 

  • American Psychiatric Association (1990) The practice of electroconvulsive therapy: recommendations for treatment, training and privileging. American Psychiatric Association, Washington DC

    Google Scholar 

  • Beale MD, Kellner CH, Pritchett JT, Bernstein HJ, Burns CM, Knapp R (1994) Stimulus dose titration in ECT: a 2-year clinical experience. Convuls Ther 10(2), 171–176

    Google Scholar 

  • Brumback RA, Staton RD (1982) The electroencephalographic pattern during electroconvulsive therapy. Clin Electroencephalogr 13:148–153

    Google Scholar 

  • Cerletti U (1956) Electroshock therapy. In: Sackler AM, Sackler MD, Saekler RR, Marti-Ibanez F (eds) The great physiodynamic therapies in psychiatry. Hoeber-Harper, New York

    Google Scholar 

  • d'Elia G, Perris C (1970) Comparison of electroconvulsive therapy with unilateral and bilateral stimulation. Acta Psychiatr Scand 215:9–29

    Google Scholar 

  • Enderle JD, Staton RD, Gerst JW, Barr CE, Brumback RA (1986) The electroencephalographic pattern during electroconvulsive therapy III. Clin Electroencephalogr 17:66–77

    Google Scholar 

  • Folkerts H (1995) Spontaneous seizure after concurrent use of methohexital anesthesia for electroconvulsive therapy and paroxetine: a case report. J Nerv Ment Dis 183(2):115–116

    Google Scholar 

  • Gerst JW, Enderle JD, Staton RD, Barr CE, Brumback RA (1982) The electroencephalographic pattern during electroconvulsive therapy II. Clin Electroencephalogr 13:251–256

    Google Scholar 

  • Gloor P, Pellegrini A, Kostopoulos GK (1979) Effects of changes in cortical excitability upon the epileptic bursts in generalized spike and wave discharges of feline generalized penicillin epilepsy of the cat. Electroencephalogr Clin Neurophysiol 46: 274–289

    Google Scholar 

  • Gutnick MJ, Prince DA (1975) Effects of projected cortical epileptic discharges of neuronal activities in ventrobasal thalamus on the cat: ictal discharge. Exp Neurol 46:418–431

    Google Scholar 

  • Halasz P (1991) Runs of rapid spikes in sleep: a characteristic EEG expression of generalized malignant epileptic encephalopathies. Epilepsy Res Suppl 2:49–71

    Google Scholar 

  • Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    Google Scholar 

  • Jahnsen H, Linás R (1984) Ionic basis for the electroresponsiveness and oscillatory properties of guinea pig thalamic neurones in vitro. J Physiol 349:227–247

    Google Scholar 

  • Kirstein L, Ottoson JO (1960) Experimental studies of electroencephalographic changes following electroconvulsive therapy. Acta psychiatri Scand 145:49–65

    Google Scholar 

  • Kostopoulos G, Antoniadis G (1992) Active role of cortical inhibition in the development of generalized epilepsy with spike-and-wave discharges: evidence from electrophysiological, microiontophoretic and simulation studies. Epilepsy Res Suppl 8: 125–133

    Google Scholar 

  • Krueger R, Fama JM, Devanand DP, Prudic J, Sackeim HA (1993) Does ECT permanently alter seizure threshold? Biol Psychiatry 33:272–276

    Google Scholar 

  • Krystal AD, Weiner RD (1994) ECT seizure therapeutic adequacy. Convuls Ther 10(2):153–164

    Google Scholar 

  • Krystal AD, Weiner RD, Coffey CE, Smith P, Arias R, Moffet E (1992) EEG evidence of more intense seizure activity with bilateral ECT. Biol Psychiatry 31:617–621

    Google Scholar 

  • Krystal AD, Weiner RD, McCall WV, Shelp FE, Arias R, Smith P (1993) The effects of ECT stimulus dose and electrode placement on the ictal electroencephalogram: an individual crossover study. Biol Psychiatry 34:759–767

    Google Scholar 

  • Krystal AD, Weiner RD, McCall WV, Coffey CE (1995) The effect of treatment number on the ictal EEG. Convuls Ther 11(1): 71

    Google Scholar 

  • McCall WV, Farah BA (1995) Greater ictal EEG regularity during RUL ECT is associated with greater treatment efficiency. Convuls Ther 11(1):69

    Google Scholar 

  • McCall WV, Shelp FE, Weiner RD, Austin S, Norris J (1993) Convulsive threshold differences in right unilateral and bilateral ECT. Biol Psychiatry 34:606–611

    Google Scholar 

  • McLachan RS, Gloor P, Avoli M (1984) Differential participation of some “specific” and “non-specific” thalamic nuclei in generalized spike and wave discharges of feline generalized penicillin epilepsy. Brain Res 307:277–287

    Google Scholar 

  • Miller AL, Faber RA, Hatch JP, Alexander HE (1985) Factors affecting amnesia, seizure duration, and efficacy in ECT. Am J Psychiatry 142:692–696

    Google Scholar 

  • Nobler MS, Sackeim HA, Solomou M, Luber B, Devanand DP, Prudic J (1993) EEG manifestations during ECT: effects of electrode placement and stimulus intensity. Biol Psychiatry 34: 321–330

    Google Scholar 

  • Ottosson JO (1960) Effect of lidocaine on the seizure discharge in electroconvulsive therapy. Acta Psychiatr Scand Suppl 145: 7–32

    Google Scholar 

  • Ottosson JO (1962) Seizure characteristics and therapeutic efficacy in electroconvulsive therapy: an analysis of the antidepressive efficacy of grand mal and lidocaine-modified seizures. J Nerv Ment Dis 135:239–251

    Google Scholar 

  • Qverall JE, Gorham DR (1962) The brief psychiatric rating scale. Psychol Rep 10:798–812

    Google Scholar 

  • Post RM, Uhde TW, Rubinow DR, Huggins T (1987) Different time course of antidepressant effects after sleep deprivation, ECT and carbamazepine: clinical and theoretical implications. Psychiatry Res 22:11–19

    Google Scholar 

  • Price TRP, Mackenzie TB, Ticker GJ (1978) The dose-response ratio in electroconvulsive therapy. Arch Gen Psychiatry 35: 1131–1136

    Google Scholar 

  • Pritchett JT, Beale MD, Burns CM, Bernstein HJ, Kellner CH (1994) Seizure suppression and concordance indices in bilateral and unilateral ECT. Convuls Ther 10:80

    Google Scholar 

  • Rasmussen KG, Zorumski CF, Jarvis MR (1994) Possible impact of stimulus duration on seizure threshold in ECT. Convuls Ther 10(2):177–180

    Google Scholar 

  • Robin A, Binnie CD, Copas CB (1985) Electrophysiological and hormonal responses to three types of electroconvulsive therapy. Br J Psychiatry 147:707–712

    Google Scholar 

  • Rodger CR, Scott AIF, Whalley LJ (1994) Is there a delay in the onset of the antidepressant effect of electroconvulsive therapy? Br J Psychiatry 164:106–109

    Google Scholar 

  • Rosen I, Silfverskiöld PTI (1987) Quantification of EEG changes following electroconvulsive therapy in depression. Eur Arch Psychiatry Neurol Sci 236(4):209–213

    Google Scholar 

  • Rossi GF, Gentilomo A (1972) The role of nonspecific thalamic nuclei in human epilepsy. In: Somjen GG (ed) Neurophysiology studied in man. Excerpta Medica, Amsterdam, pp 126–135

    Google Scholar 

  • Sackeim HA (1994) Physical properties of the ECT stimulus. Convuls Ther 10(2):140–152

    Google Scholar 

  • Sackeim HA, Decina P, Prohovnik I, Malitz S (1987) Seizure threshold in electroconvulsive therapy: effects of sex, age, electrode placement and number of treatments. Arch Gen Psychiatry 44:355–360

    Google Scholar 

  • Sackeim HA, Devanand DP, Prudic J (1991) Stimulus intensity, seizure threshold and seizure duration: impact on the efficacy and safety of ECT. Psychiatr Clin North Am 14:803–844

    Google Scholar 

  • Sackeim HA, Prudic J, Devanand DP (1993) Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med 328:839–846

    Google Scholar 

  • Scott AF, Whalley LJ (1993) The onset and rate of the antidepressant effect of electroconvulsive therapy. Br J Psychiatry 162: 725–732

    Google Scholar 

  • Small JG, Small IF, Perez HC, Sharpley P (1970) Electroencephalographic and neurophysiological studies of electrically induced seizures. J Nerv Ment Dis 150:479–489

    Google Scholar 

  • Staton RD, Enderle JD, Gerst JW (1986) The electroencephalographic pattern during electroconvulsive therapy IV. Clin Electroencephalogr 17:203–215

    Google Scholar 

  • Staton RD, Enderle JD, Gerst JW (1988) The electroencephalographic pattern during electroconvulsive therapy V. Clin Electroencephalogr 19:176–198

    Google Scholar 

  • Swartz CM (1993a) Clinical and laboratory predictors of ECT response. In: Coffey CE (ed) The clinical science of ECT. American Psychiatric Press, Washington DC, pp 53–72

    Google Scholar 

  • Swartz CM (1993b) Anesthesia for ECT. Convuls Ther 9(4): 301–316

    Google Scholar 

  • Swartz CM (1993c) Beyond seizure duration as a measure of treatment quality. Convuls Ther 9:1–7

    Google Scholar 

  • Swartz CM (1994) Asymmetric bilateral right frontotemporal left frontal stimulus electrode placement for electroconvulsive therapy. Neuropsychobiology 29:174–178

    Google Scholar 

  • Swartz CM, Larson G (1986) Generalisation of the effects of unilateral and bilateral ECT. Am J Psychiatry 143:1040–1041

    Google Scholar 

  • Tresise PC, Stenhouse NS (1968) ECT phases with and without anaesthesia: a preliminary statistical study. Br J Psychiatry 114: 1383–1386

    Google Scholar 

  • Weiner RD (1980a) The persistence of electroconvulsive therapy-induced changes in the electroencephalogram. J Nerv Ment Dis 168:224–228

    Google Scholar 

  • Weiner RD (1980b) ECT and seizure threshold: effects of stimulus waveform and electrode placement. Biol Psychiatry 15: 78–81

    Google Scholar 

  • Weiner RD (1982) Electroencephalographic correlates of ECT. Psychopharmacol Bull 18:78–81

    Google Scholar 

  • Weiner RD, Coffey CE, Krystal AD (1991) The monitoring and management of electrically induced seizures. Psychiatr Clin North Am 14(4):845–869

    Google Scholar 

  • Weiner RD, Krystal AD (1993) EEG monitoring and management of electrically induced seizures. In: Coffey CE (ed) The clinical science of ECT. American Psychiatric Press, Washington DC, pp 93–109

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Folkerts, H. The ictal electroencephalogram as a marker for the efficacy of electroconvulsive therapy. Eur Arch Psychiatry Clin Nuerosci 246, 155–164 (1996). https://doi.org/10.1007/BF02189117

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02189117

Key words

Navigation