EEG seizure duration monitoring of ECT

The use of electroencephalographical monitoring in convulsive therapy has gained widespread acceptance in the United States where devices with this capability are readily available. In other countries, clinical monitoring alone is more common. Discrepancies between electroencephalographic and clinical observation (such as the "cuff method" described below) have been known to exist. Duration guidelines have evolved based on concerns about decreased effectiveness of very short seizures and neurotoxicity of overly long seizures. While these guidelines need further research to verify the assumptions they are based on, they have been recommended for use in clinical decision making. Currently available guidelines do not indicate how to manage disparate results when two measurement methods are used simultaneously. The authors examine the controversy and report the frequency of discrepancies across several guidelines.