Seizure threshold determination for electroconvulsive therapy: stimulus dose titration versus age-based estimations.
OBJECTIVE
This study compared electroconvulsive therapy (ECT) seizure threshold determined by stimulus dose titration with age-based estimations.


METHODS
Patients with major depressive disorder had their initial seizure thresholds determined by stimulus dose titration and the results compared with age-based estimations. There are no significant differences in thresholds determined by these methods.


RESULTS
Two hundred and three psychiatric patients (149 females, 54 males) had their seizure thresholds determined by stimulus dose titration. There was a significant positive correlation between seizure thresholds and age for males and females with male thresholds greater than female thresholds. Age determinations of seizure threshold would have resulted in excessive initial treatment stimuli for 30% of females and 8% of males. Ineffective stimulus doses would have been given to 2% of females and 7% of males on a full age basis and 64% using a half age strategy.


CONCLUSIONS
For effective high-dose right unilateral ECT, initial seizure threshold should be determined by stimulus dose titration.
Department of Psychiatry, The University of Melbourne, Victoria, Australia. tillerj@ramsayhealth.com.au
John W G
JW
Tiller
Nicholas
N
Ingram
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001921:Brain / Q000503:physiopathology*; D003865:Major Depressive Disorder / Q000628:therapy*; D004565:Electroconvulsive Therapy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000175:diagnosis* / Q000453:epidemiology*; D012720:Severity of Illness Index