Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study
At the start and during the course of electroconvulsive therapy (ECT), estimation of the seizure threshold (ST) is useful in weighing the expected effectiveness against the risks of side effects. Therefore, this study explores clinical factors predicting initial ST (IST) and levels of ST during the...
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| Veröffentlicht in: | European archives of psychiatry and clinical neuroscience 2013-03, Vol.263 (2), p.167-175 |
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| creator | van Waarde, Jeroen A. van Oudheusden, Lucas J. B. Verwey, Bastiaan Giltay, Erik J. van der Mast, Rose C. |
| description | At the start and during the course of electroconvulsive therapy (ECT), estimation of the seizure threshold (ST) is useful in weighing the expected effectiveness against the risks of side effects. Therefore, this study explores clinical factors predicting initial ST (IST) and levels of ST during the ECT course. This prospective observational study included patients aged ≥18 years receiving ECT without contraindications for dose titration. At the first and every sixth consecutive ECT session, ST level was measured. Using multivariate linear regression and multilevel models, predictors for IST and change in ST levels were examined. A total of 91 patients (mean age, 59.1 ± 15.0 years; 37 % male; 97 % diagnosis of depression) were included. In multivariable analysis, higher age (β = 0.24;
P
= 0.03) and bifrontotemporal (BL) electrode placement (β = 0.42;
P
|
| doi_str_mv | 10.1007/s00406-012-0342-7 |
| format | Article |
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P
= 0.03) and bifrontotemporal (BL) electrode placement (β = 0.42;
P
< 0.001) were independent predictors for higher IST, explaining 49 % of its variation. Also, these two variables independently predicted higher ST levels at different time points during the course. Using multilevel models, absence of a previous ECT course(s) predicted a steeper rise in ST during the course (
P
= 0.03 for the interaction term time*previous ECT). The age-adjusted dose-titration method is somewhat crude, resulting in some measurement error. Concomitant medication use could have influenced ST levels. Increasing age and BL electrode placement predicted higher (I)ST, which should be taken into account when selecting ECT dosage. Previous ECT course(s) may avoid an increase in ST during the course of ECT.</description><identifier>ISSN: 0940-1334</identifier><identifier>EISSN: 1433-8491</identifier><identifier>DOI: 10.1007/s00406-012-0342-7</identifier><identifier>PMID: 22797771</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer-Verlag</publisher><subject>Adult ; Age ; Age Factors ; Aged ; Cohort Studies ; Depression ; Depressive Disorder - therapy ; ECS ; Electroconvulsive Therapy - methods ; Electrodes ; Electroencephalography ; Female ; Humans ; Linear Models ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Nervous system ; Neurosciences ; Original Paper ; Prospective Studies ; Psychiatry ; Regression analysis ; Seizures ; Seizures - physiopathology ; Side effects ; Titration</subject><ispartof>European archives of psychiatry and clinical neuroscience, 2013-03, Vol.263 (2), p.167-175</ispartof><rights>The Author(s) 2012</rights><rights>Springer-Verlag Berlin Heidelberg 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c503t-5bd20192b7e049916a6b2463729210679ca3a509de281561288e85896544eb7b3</citedby><cites>FETCH-LOGICAL-c503t-5bd20192b7e049916a6b2463729210679ca3a509de281561288e85896544eb7b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00406-012-0342-7$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00406-012-0342-7$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22797771$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Waarde, Jeroen A.</creatorcontrib><creatorcontrib>van Oudheusden, Lucas J. B.</creatorcontrib><creatorcontrib>Verwey, Bastiaan</creatorcontrib><creatorcontrib>Giltay, Erik J.</creatorcontrib><creatorcontrib>van der Mast, Rose C.</creatorcontrib><title>Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study</title><title>European archives of psychiatry and clinical neuroscience</title><addtitle>Eur Arch Psychiatry Clin Neurosci</addtitle><addtitle>Eur Arch Psychiatry Clin Neurosci</addtitle><description>At the start and during the course of electroconvulsive therapy (ECT), estimation of the seizure threshold (ST) is useful in weighing the expected effectiveness against the risks of side effects. Therefore, this study explores clinical factors predicting initial ST (IST) and levels of ST during the ECT course. This prospective observational study included patients aged ≥18 years receiving ECT without contraindications for dose titration. At the first and every sixth consecutive ECT session, ST level was measured. Using multivariate linear regression and multilevel models, predictors for IST and change in ST levels were examined. A total of 91 patients (mean age, 59.1 ± 15.0 years; 37 % male; 97 % diagnosis of depression) were included. In multivariable analysis, higher age (β = 0.24;
P
= 0.03) and bifrontotemporal (BL) electrode placement (β = 0.42;
P
< 0.001) were independent predictors for higher IST, explaining 49 % of its variation. Also, these two variables independently predicted higher ST levels at different time points during the course. Using multilevel models, absence of a previous ECT course(s) predicted a steeper rise in ST during the course (
P
= 0.03 for the interaction term time*previous ECT). The age-adjusted dose-titration method is somewhat crude, resulting in some measurement error. Concomitant medication use could have influenced ST levels. Increasing age and BL electrode placement predicted higher (I)ST, which should be taken into account when selecting ECT dosage. Previous ECT course(s) may avoid an increase in ST during the course of ECT.</description><subject>Adult</subject><subject>Age</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Cohort Studies</subject><subject>Depression</subject><subject>Depressive Disorder - therapy</subject><subject>ECS</subject><subject>Electroconvulsive Therapy - methods</subject><subject>Electrodes</subject><subject>Electroencephalography</subject><subject>Female</subject><subject>Humans</subject><subject>Linear Models</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Nervous system</subject><subject>Neurosciences</subject><subject>Original Paper</subject><subject>Prospective Studies</subject><subject>Psychiatry</subject><subject>Regression analysis</subject><subject>Seizures</subject><subject>Seizures - physiopathology</subject><subject>Side effects</subject><subject>Titration</subject><issn>0940-1334</issn><issn>1433-8491</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkUGLFDEQhYMo7uzqD_AiDV68tFYl6aTjQZBBV2HBi168hHS6ZidLT6dNugfGX2_GWZdVEMwlkPe9l6QeY88QXiGAfp0BJKgakNcgJK_1A7ZCKUTdSoMP2QqMhBqFkGfsPOcbAMCGw2N2xrk2WmtcsW_rIYzBu6GaEvXBzzHlKm6qTOHHkqiat4nyNg59FcaKBvJzij6O-2XIYX-UKbnp8KZyxR_zVPTjcZ6X_vCEPdq4IdPT2_2Cff3w_sv6Y331-fLT-t1V7RsQc910PQc0vNME0hhUTnVcKqG54QhKG--Ea8D0xFtsFPK2pbZpjWqkpE534oK9PeVOS7ej3tM4JzfYKYWdSwcbXbB_KmPY2uu4t6JpFQpVAl7eBqT4faE8213InobBjRSXbFFgq4xC_C9UamjQiIK--Au9iUsayyR-USWtrELhifJlfDnR5u7dCPZYsj2VbEvJ9liy1cXz_P6H7xy_Wy0APwG5SOM1pXtX_zP1JzMmsa4</recordid><startdate>20130301</startdate><enddate>20130301</enddate><creator>van Waarde, Jeroen A.</creator><creator>van Oudheusden, Lucas J. 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B. ; Verwey, Bastiaan ; Giltay, Erik J. ; van der Mast, Rose C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c503t-5bd20192b7e049916a6b2463729210679ca3a509de281561288e85896544eb7b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Age</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Cohort Studies</topic><topic>Depression</topic><topic>Depressive Disorder - therapy</topic><topic>ECS</topic><topic>Electroconvulsive Therapy - methods</topic><topic>Electrodes</topic><topic>Electroencephalography</topic><topic>Female</topic><topic>Humans</topic><topic>Linear Models</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Nervous system</topic><topic>Neurosciences</topic><topic>Original Paper</topic><topic>Prospective Studies</topic><topic>Psychiatry</topic><topic>Regression analysis</topic><topic>Seizures</topic><topic>Seizures - physiopathology</topic><topic>Side effects</topic><topic>Titration</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Waarde, Jeroen A.</creatorcontrib><creatorcontrib>van Oudheusden, Lucas J. B.</creatorcontrib><creatorcontrib>Verwey, Bastiaan</creatorcontrib><creatorcontrib>Giltay, Erik J.</creatorcontrib><creatorcontrib>van der Mast, Rose C.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Psychology</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European archives of psychiatry and clinical neuroscience</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Waarde, Jeroen A.</au><au>van Oudheusden, Lucas J. B.</au><au>Verwey, Bastiaan</au><au>Giltay, Erik J.</au><au>van der Mast, Rose C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study</atitle><jtitle>European archives of psychiatry and clinical neuroscience</jtitle><stitle>Eur Arch Psychiatry Clin Neurosci</stitle><addtitle>Eur Arch Psychiatry Clin Neurosci</addtitle><date>2013-03-01</date><risdate>2013</risdate><volume>263</volume><issue>2</issue><spage>167</spage><epage>175</epage><pages>167-175</pages><issn>0940-1334</issn><eissn>1433-8491</eissn><abstract>At the start and during the course of electroconvulsive therapy (ECT), estimation of the seizure threshold (ST) is useful in weighing the expected effectiveness against the risks of side effects. Therefore, this study explores clinical factors predicting initial ST (IST) and levels of ST during the ECT course. This prospective observational study included patients aged ≥18 years receiving ECT without contraindications for dose titration. At the first and every sixth consecutive ECT session, ST level was measured. Using multivariate linear regression and multilevel models, predictors for IST and change in ST levels were examined. A total of 91 patients (mean age, 59.1 ± 15.0 years; 37 % male; 97 % diagnosis of depression) were included. In multivariable analysis, higher age (β = 0.24;
P
= 0.03) and bifrontotemporal (BL) electrode placement (β = 0.42;
P
< 0.001) were independent predictors for higher IST, explaining 49 % of its variation. Also, these two variables independently predicted higher ST levels at different time points during the course. Using multilevel models, absence of a previous ECT course(s) predicted a steeper rise in ST during the course (
P
= 0.03 for the interaction term time*previous ECT). The age-adjusted dose-titration method is somewhat crude, resulting in some measurement error. Concomitant medication use could have influenced ST levels. Increasing age and BL electrode placement predicted higher (I)ST, which should be taken into account when selecting ECT dosage. Previous ECT course(s) may avoid an increase in ST during the course of ECT.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer-Verlag</pub><pmid>22797771</pmid><doi>10.1007/s00406-012-0342-7</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Age Age Factors Aged Cohort Studies Depression Depressive Disorder - therapy ECS Electroconvulsive Therapy - methods Electrodes Electroencephalography Female Humans Linear Models Male Medicine Medicine & Public Health Middle Aged Nervous system Neurosciences Original Paper Prospective Studies Psychiatry Regression analysis Seizures Seizures - physiopathology Side effects Titration |
| title | Clinical predictors of seizure threshold in electroconvulsive therapy: a prospective study |
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