title: Augmentation of seizure induction in electroconvulsive therapy: a clinical reappraisal.
abstract: OBJECTIVE
  Missed or abortive seizures during electroconvulsive therapy (ECT) may preclude completion of an effective course of treatment in some cases. Seizure augmentation, using proconvulsant agents, has been used to overcome resistance to the induction and continuation of seizure activity. In this review, we analyze published clinical data on the effects and safety of seizure augmentation techniques.
  
  
  METHODS
  Clinical studies and case reports were obtained through a MEDLINE literature search from 1966 to 2001, cross-referencing ECT and proconvulsant agents. Article references were also scanned for relevant studies.
  
  
  CONCLUSIONS
  Data from clinical trials indicate that augmentation facilitates seizure induction when maximal electrical stimuli fail. Anesthetic modifications, including hyperventilation and substitution with etomidate, ketamine, or other agents, often are successful in overcoming seizure resistance and compare favorably with the use of caffeine. In a few studies, augmentation enabled the use of lower stimulus intensities and fewer treatments without loss of efficacy, even in patients not resistant to seizure induction. However, effects of proconvulsants must be reconciled with increasing evidence of the importance of stimulus dosing relative to seizure threshold and other parameters, now considered key to the efficacy of ECT. Further investigations of pharmacologic augmentation could facilitate the administration of ECT and could provide further insights concerning parameters of seizure efficacy and the mechanism of action underlying convulsive therapies.
authors.affiliation: Department of Psychiatry, University of Pennsylvania School of Medicine and the Department of Veterans Affairs Medical Center, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Datto
authors.forename: Anil K
authors.initials: AK
authors.lastname: Rai
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Ilivicky
authors.forename: Stanley N
authors.initials: SN
authors.lastname: Caroff
mesh_terms: D000777:Anesthetics / Q000627:therapeutic use; D002110:Caffeine / Q000627:therapeutic use; D004565:Electroconvulsive Therapy / Q000379:methods* / Q000592:standards*; D006801:Humans; D010100:Oxygen / Q000627:therapeutic use; D011619:Psychotropic Drugs / Q000627:therapeutic use; D013806:Theophylline / Q000627:therapeutic use
chemical_list: D000777:Anesthetics; D011619:Psychotropic Drugs; D002110:Caffeine; D013806:Theophylline; D010100:Oxygen