Ictal rpp - a supplement to cuff method in detecting ect-induced cerebral seizure

During electroconvulsive therapy (ECT), occurrence of seizure must be confirmed. Cuff method, although simple and reliable, can sometimes miss an adequate EEG seizure. Predictable cardiovascular response occurs during ECT seizure. We examined if this can be an additional guide to detect cerebral seizure. In 164 modified ECT sessions, EEG and cuff methods were used for seizure monitoring. Heart rate (HR in beats per minute) and blood pressure (BP in mm of Hg) were recorded before (baseline) and 20 seconds after the stimulus (ictal). The rate pressure product (RPP=HR x systolic BP) was computed. The ECT sessions consisted of three groups, viz., adequate EEG and motor seizure (n=126), adequate EEG but not motor seizure (n=21) and neither EEG nor motor seizure adequate (n=17). Significant elevation of RPP occurred from baseline to 'ictal' recording and this was different between the three groups. Ictal RPP did not differ between groups with or without adequate motor seizure if EEG seizure was adequate. The group with no adequate EEG or motor seizure had the least 'ictal' RPP. Findings suggest that RPP response can be an additional clinical measure to detect seizures during ECT.