Prediction of the utility of a switch from unilateral to bilateral ECT in the elderly using treatment 2 ictal EEG indices

The Journal of ECT
A D KrystalC E Coffey

Abstract

The choice of whether to administer nondominant unilateral (UL) or bilateral (BL) ECT remains controversial. A study in which moderately suprathreshold UL nonresponders at treatment 6 were randomized to UL or BL ECT offered the opportunity to explore whether ictal EEG indices at treatment 2 might predict response to UL ECT, and also which UL ECT nonresponders are likely to respond to BL ECT. We found that less postictal suppression in response to the second UL ECT stimulus was predictive of a poorer subsequent therapeutic response to UL ECT, but of a better therapeutic response if switched to BL ECT. A multivariate ictal EEG model was developed that had a significant capacity to differentiate those who will respond to UL ECT versus those who will not respond to UL ECT, but who will be therapeutic responders when switched to BL ECT. This study raises the possibility that ictal EEG indices at treatment 2 may identify situations when UL ECT is physiologically and therapeutically inadequate, and when BL ECT is likely to be more effective. The determination of whether such predictive physiologic models are of clinical utility for the prediction of outcome awaits further study.

References

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Citations

Jun 18, 2003·Bulletin of the Menninger Clinic·Keith G Rasmussen
Dec 6, 2003·The Journal of ECT·Chadi A CalargeRobert P From
Jun 18, 2011·The Journal of ECT·Kyle A B Lapidus, Charles H Kellner
Jun 13, 2002·Mayo Clinic Proceedings·Keith G RasmussenTeresa A Rummans
Mar 4, 2015·Nordic Journal of Psychiatry·Gulnihal Gokce SimsekYasemin Sipka Kurtulmus
Jun 14, 2003·The Cochrane Database of Systematic Reviews·F B Van der WurffA T Beekman
Jan 22, 2004·Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology·Tarique D PereraHarold A Sackeim
Jun 8, 2018·European Archives of Psychiatry and Clinical Neuroscience·Laura KranasterAlexander Sartorius
Jul 20, 2018·European Archives of Psychiatry and Clinical Neuroscience·Isabelle Brunner, Michael Grözinger

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