Approaches for difficult-to-induce-seizures electroconvulsive therapy cases (DEC): a Japanese expert consensus

Area of Science:

• Neuroscience
• Psychiatry
• Clinical Medicine

Background:

• Seizure threshold increases with age and electroconvulsive therapy (ECT) frequency.
• Difficult-to-induce-seizures electroconvulsive therapy cases (DECs) pose clinical challenges due to lack of guidelines.
• This study sought expert consensus on managing DECs.

Purpose of the Study:

• To establish expert consensus on treatment strategies for difficult-to-induce-seizures electroconvulsive therapy (DECs).
• To provide clinical guidance for managing patients with DECs.

Main Methods:

• Japanese ECT experts rated 14 approaches for DECs on a 9-point Likert scale.
• 195 experts participated, and responses classified approaches into first-line, second-line, or third-line strategies.
• Treatments of choice were defined as those rated 9 by at least 50% of respondents.

Main Results:

• Dose reduction of benzodiazepine receptor agonists (BZRAs), dose reduction/discontinuation of antiepileptic drugs (AEDs), and ensuring hyperventilation were treatments of choice.
• First-line strategies included BZRA discontinuation, stimulation timing adjustment, and anesthetic dose reduction.
• While some strategies are universally applicable, others require tailoring for specific conditions like catatonia or cardiovascular risks.

Conclusions:

• ECT expert recommendations offer valuable clinical decision-making support for DECs.
• A combination of universal and condition-specific strategies is recommended for managing DECs.
• Further clinical studies are needed to validate these expert-derived recommendations.