Effect of esmolol pretreatment on EEG seizure morphology in RUL ECT

Intravenous beta-blockers are an effective means of controlling heart rate and blood pressure during electroconvulsive therapy (ECT), but have been shown to decrease seizure duration. While the importance of seizure duration to the antidepressant response of ECT grows less certain, there is growing evidence that seizure morphology predicts the antidepressant effect of ECT. This study examined the impact of esmolol pretreatment on seizure morphology. Eighteen depressed patients (6 men, 12 women; 69 +/- 12.8 years old) received ECT with and without esmolol pretreatment in a randomized, blinded crossover design. The seizures were blindly rated for duration of motor convulsion, duration of electroencephalogram (EEG) seizure, degree of seizure regularity, and degree of postictal EEG suppression. Esmolol shortened the duration of the motor convulsion and degraded the quality of the ictal regularity. Routine administration of intravenous esmolol before ECT may cause a decrease in ictal regularity. Careful consideration should be given to the potential benefits of esmolol versus the deleterious effect on the electrophysiologic process. Esmolol may still be indicated on a case-by-case basis for extreme tachycardia or hypertension associated with ECT, and presumably poses no problem for the therapeutic effect of ECT if given after the seizure is over.