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The Ictal EEG in ECT: A Systematic Review of the Relationships Between Ictal Features, ECT Technique, Seizure Threshold and Outcomes
Brain Stimulation ( IF 7.6 ) Pub Date : 2020-11-01 , DOI: 10.1016/j.brs.2020.09.009
Rohan Francis-Taylor , Gillian Ophel , Donel Martin , Colleen Loo

OBJECTIVE To provide guidance for ECT practitioners in utilising the ictal EEG to inform treatment decisions. METHODS A systematic review of studies examining the ictal EEG, treatment technique, seizure threshold and treatment outcomes was conducted. MEDLINE, EMBASE and PsycINFO databases were searched up to 31st July 2019. Studies were included if they examined the use of ECT in human subjects and compared an ictal EEG analysis (either quantitative or manually rated) with either: a) clinical outcomes, b) seizure threshold/threshold change, c) ECT dosing decisions, or d) different aspects of ECT technique (comparison of different electrode placements, pulse widths, waveforms, or dose/dose relative to seizure threshold). RESULTS A total of 853 studies were identified, with 44 meeting inclusion criteria. A qualitative review revealed ictal EEG indices have been linked to therapeutic outcome, though the strength of this relationship appears modest. Ictal EEG features are influenced by variations in ECT treatment technique. Serial ictal EEG monitoring can detect changes in seizure threshold across an ECT course for right unilateral brief and ultrabrief pulse ECT. CONCLUSION While there is some relationship between ictal EEG manifestation and treatment outcomes, the primary utility of ictal EEG monitoring during an ECT course may lie in the capacity to detect changes in seizure threshold and adjust dosing accordingly. Prospective validation of a dosing regime informed by serial ictal EEG monitoring is warranted.

中文翻译:

ECT 中的发作期脑电图:对发作期特征、ECT 技术、癫痫发作阈值和结果之间关系的系统评价

目的 为 ECT 从业者提供指导,以利用发作期脑电图为治疗决策提供信息。方法 对检查发作期脑电图、治疗技术、癫痫发作阈值和治疗结果的研究进行系统评价。MEDLINE、EMBASE 和 PsycINFO 数据库的搜索截止日期为 2019 年 7 月 31 日。如果研究检查了 ECT 在人类受试者中的使用情况,并将发作期脑电图分析(定量或手动评级)与以下任一情况进行比较:a) 临床结果,b)癫痫发作阈值/阈值变化,c) ECT 剂量决定,或 d) ECT 技术的不同方面(不同电极放置、脉冲宽度、波形或剂量/剂量相对于癫痫发作阈值的比较)。结果 共确定了 853 项研究,其中 44 项符合纳入标准。一项定性审查显示,发作期脑电图指数与治疗结果有关,尽管这种关系的强度似乎不大。发作期脑电图特征受 ECT 治疗技术变化的影响。连续发作期脑电图监测可以检测右侧单侧短暂和超短脉冲 ECT 整个 ECT 过程中癫痫发作阈值的变化。结论 虽然发作期脑电图表现与治疗结果之间存在某种关系,但在 ECT 过程中发作期脑电图监测的主要用途可能在于能够检测癫痫发作阈值的变化并相应地调整剂量。有必要对由连续发作期脑电图监测告知的给药方案进行前瞻性验证。发作期脑电图特征受 ECT 治疗技术变化的影响。连续发作期脑电图监测可以检测右侧单侧短暂和超短脉冲 ECT 整个 ECT 过程中癫痫发作阈值的变化。结论 虽然发作期脑电图表现与治疗结果之间存在某种关系,但在 ECT 过程中发作期脑电图监测的主要用途可能在于能够检测癫痫发作阈值的变化并相应地调整剂量。有必要对由连续发作期脑电图监测告知的给药方案进行前瞻性验证。发作期脑电图特征受 ECT 治疗技术变化的影响。连续发作期脑电图监测可以检测右侧单侧短暂和超短脉冲 ECT 整个 ECT 过程中癫痫发作阈值的变化。结论虽然发作期脑电图表现与治疗结果之间存在某种关系,但在 ECT 过程中发作期脑电图监测的主要用途可能在于能够检测癫痫发作阈值的变化并相应地调整剂量。有必要对由连续发作期脑电图监测告知的给药方案进行前瞻性验证。ECT 过程中发作期 EEG 监测的主要用途可能在于检测癫痫发作阈值变化并相应调整剂量的能力。有必要对由连续发作的脑电图监测告知的给药方案进行前瞻性验证。ECT 过程中发作期 EEG 监测的主要用途可能在于检测癫痫发作阈值变化并相应调整剂量的能力。有必要对由连续发作期脑电图监测告知的给药方案进行前瞻性验证。
更新日期:2020-11-01
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