Focal prefrontal seizures induced by bilateral ECT
L S Boylan1, D P Devanand, S H Lisanby
1Department of Neurology, New York University School of Medicine, New York, New York, USA.
The Journal of ECT
|August 31, 2001
Summary
Bilateral electroconvulsive therapy (ECT) may induce focal seizures in prefrontal areas, unlike right unilateral ECT. These seizures are more likely to occur later in the treatment course.
Area of Science:
- Neuroscience
- Psychiatry
- Medical Devices
Background:
- Bilateral (BL) electroconvulsive therapy (ECT) shows greater efficacy than right unilateral (RUL) ECT at low stimulus intensity.
- Differences in seizure initiation site are proposed as a reason for this efficacy.
- This study investigates the hypothesis that focal prefrontal seizures are more common with BL than RUL ECT.
Purpose of the Study:
- To determine if bilateral ECT administration is associated with a higher incidence of focal prefrontal seizures compared to right unilateral ECT.
- To explore the characteristics of electroencephalographic seizures without motor manifestations during ECT.
Main Methods:
- A retrospective review of 1,007 electroconvulsive therapy (ECT) treatments was conducted.
- Data from 84 consecutive patients randomized to either right unilateral (RUL) or bilateral (BL) electrode placement were analyzed.
- Electroencephalographic (EEG) seizure activity without motor manifestations was identified.
Main Results:
- Eight instances of electroencephalographic seizures without motor manifestations were recorded.
- All identified events occurred during titration sessions and specifically with bilateral (BL) stimuli (p = 0.002).
- These seizure events demonstrated a higher likelihood of occurring later in the course of ECT treatment.
Conclusions:
- Bilateral electroconvulsive therapy (ECT) may induce focal seizures, potentially in prefrontal areas.
- The occurrence of these focal seizures appears to be more probable later in the treatment regimen.
- Findings suggest a link between BL ECT, focal seizure activity, and treatment timing.
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