PMID: 16633209Apr 25, 2006Paper

Electroconvulsive therapy stimulus dose expressed as volume of seizure foci

The Journal of ECT
C M Swartz

Abstract

Electrical stimulus dose is typically stated as charge in millicoulombs (mC), representing the number of electrons. However, by overlooking the voltage threshold for neuronal depolarization, charge alone is inappropriate. Any charge can accumulate from subthreshold voltage over time. Stimulus energy represents heat content; without a delivery rate, it is not related to depolarization voltage. The objective was to formulate stimulus dose in accordance with seizure induction physiology. Stimulus dose was expressed as volume of generated seizure foci, a variable dependent on current and charge. A second more detailed model considers brain voltages as related to clinical deep brain stimulation. For the constant current stimuli characteristic of widely available American stimulators, stimulus dose is proportional to current cubed multiplied by charge. This relationship corresponds to the 3 dimensions of a voltage field in space, where the volume above a certain voltage increases with the cube of the voltage radius. As a consequence, any particular charge at 0.9 A (ampere) current has a seizure foci dose approximately 50% higher than the same charge at 0.8 A. The modeling offers an explanation for published measurements comparing ins...Continue Reading

References

Mar 1, 1993·Electroencephalography and Clinical Neurophysiology·S S NathanN V Thakor
Sep 1, 1994·Annals of Clinical Psychiatry : Official Journal of the American Academy of Clinical Psychiatrists·C M Swartz
Jan 5, 2000·The American Journal of Psychiatry·S H BailineS Pollack
Aug 31, 2000·The American Journal of Psychiatry·C M Swartz, D T Manly
Apr 3, 2001·The Journal of ECT·C Andrade
Oct 18, 2002·Epilepsia·Eiju WatanabeYoshiaki Mayanagi

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Citations

Apr 22, 2009·European Archives of Psychiatry and Clinical Neuroscience·Jeroen A van WaardeRose C van der Mast
Jan 25, 2016·Revista de psiquiatrí́a y salud mental·Javier Salvador SánchezMaría Mur Laín
Mar 16, 2012·Psychiatry Research·Conrad Melton SwartzNikolaus Michael
Oct 24, 2019·ELife·Miklos ArgyelanChristopher Abbott
Dec 19, 2020·The Journal of ECT·Tomonori MurayamaChiaki Kawanishi

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