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Updated: Apr 3, 2026
Pupillary Response as Assessment of Effective Seizure Induction by Electroconvulsive Therapy
Published on: April 11, 2019
Seizure Adequacy Markers and the Prediction of Electroconvulsive Therapy Response
Alessandra Minelli1, Maria Abate, Elisa Zampieri
1From the *Department of Molecular and Translational Medicine, Biology and Genetic Division, University of Brescia, Brescia; †Psychiatric Hospital "Villa Santa Chiara"; and ‡Department of Philosophy, Education, Psychology University of Verona, Verona; §Genetic Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia; and ∥Department of Psychiatry, Central Hospital of Bolzano, Bolzano, Italy.
Objectives:
Electroconvulsive therapy (ECT) is the most effective therapy for patients with treatment-resistant depression; however, some patients do not respond or relapse in a short time. Electroconvulsive therapy stimulus parameters may be related to the outcome. We carried out a retrospective study review to investigate various ECT parameters in relation to the outcome, clinical variables, and pharmacological treatments. Our aim was to understand which factors could be considered putative seizure quality markers and which are relevant to clinical practice.
Methods:
Two physicians evaluated the seizure length, the postictal suppression index, the wave amplitude, tachycardia, and hemispheric brain wave synchronicity in a double-blind manner for 45 treatment-resistant depression patients receiving ECT.
Results:
The analysis showed a significant association between the outcome and the ECT seizure quality measured by the parameters (P = 9.9 × 10). Among patients with poor-quality seizures, 61.5% relapsed after approximately 1 month from the last ECT session. Particularly, there was an association between higher symptomatology decrease and higher quality of hemispheric brain wave synchronicity (P = 5.0 × 10), as well as a higher wave amplitude (P = 0.01).
Conclusions:
Our results confirm that ECT seizure quality was strongly correlated with the decrease of depressive symptomatology.
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