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López-Ilundain J, Prados AB, Enriquez ÁSR, Enguita-Germán M, Rosquil EU, Gil JL, Fábrega AM, Martinez de Zabarte Moraza E, Maughan AR, Yoldi-Murillo J. Does Lidocaine Shorten Seizure Duration in Electroconvulsive Therapy? PHARMACOPSYCHIATRY 2023; 56:197-203. [PMID: 37643731 DOI: 10.1055/a-2114-4327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is an effective short-term treatment for schizophrenia and depression, amongst other disorders. Lidocaine is typically added to reduce pain from intravenous propofol injection. However, depending on the dose used in the ECT setting, it can shorten seizure duration. The aim of this study was to investigate the effect of lidocaine dose on seizure duration. METHODS This retrospective, naturalistic cohort study included 169 patients treated with ECT. We examined 4714 ECT sessions with propofol or propofol plus lidocaine. Ictal quality was manually rated by visual inspection. The main outcome of this study was the relation of lidocaine with seizure duration after controlling for socio-demographic, ECT, and other anesthetic variables. RESULTS There was a significant negative association between lidocaine usage and seizure duration. Multivariate analyses showed that seizure duration was shortened by an average of 3.21 s in sessions with lidocaine. Moreover, in this subgroup, there was a significant negative dose-dependent association between lidocaine dose and seizure length. Complementarily, a significant positive association between preictal BIS and seizure length was found in the subgroup of sessions where preictal was used. CONCLUSIONS We provide additional evidence highlighting the importance of caution regarding lidocaine dosing due to the effect on seizure length in the ECT setting. It is advisable for clinicians to exercise caution when administering lidocaine regarding its dosing and seizure length in ECT settings. Future investigation is needed to assess causal relationships by studying certain vulnerable groups or employing other charge calculation techniques, such as the titration method.
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Affiliation(s)
- Jose López-Ilundain
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Alejandro Ballesteros Prados
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba Mental Health Network, Araba Psychiatric Hospital, Vitoria-Gasteiz, Spain
| | - Ángela S Rosero Enriquez
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Mónica Enguita-Germán
- Navarrabiomed-HUN-UPNA, Unidad de Metodología. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | | | - Jose López Gil
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Ana Marmol Fábrega
- Department of Psychiatry, Hospital Universitario de Navarra, Pamplona, Spain. Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | | | | | - Javier Yoldi-Murillo
- Department of Anaesthesiology, Hospital Universitario de Navarra, Pamplona, Spain
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Kumar S, Rodriguez AJ, Burbridge MA. Intraoperative Seizure Under General Anesthesia Not Detected by EEG: A Case Report. Cureus 2023; 15:e42765. [PMID: 37663980 PMCID: PMC10468727 DOI: 10.7759/cureus.42765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2023] [Indexed: 09/05/2023] Open
Abstract
Intraoperative seizures under general anesthesia are infrequent. However, seizure activity under general anesthesia confirmed by contemporaneous EEG has been reported. We describe the case of a 39-year-old female undergoing right frontal brain tumor resection who experienced an intraoperative seizure. Intraoperative neuromonitoring was utilized and included four channels of EEG, somatosensory evoked potentials (SSEP), and transcranial motor evoked potentials (MEP). During this operation, characteristic motor manifestations of a seizure occurred. However, the EEG did not demonstrate seizure activity due to limitations in EEG lead placement. Post-operatively in the ICU, motor manifestations of seizure activity continued, and subsequent EEG recordings demonstrated classic seizure activity. Due to the previous hemicraniectomy, corkscrew EEG electrodes were not placed over the right skull defect, thereby failing to detect the intraoperative seizure. Anesthesiologists should be aware that limitations with EEG electrode placement can fail to detect intraoperative seizures, and treatment to extinguish the seizure should proceed in an emergent fashion.
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Affiliation(s)
- Sumanya Kumar
- Anesthesiology, University of Connecticut School of Medicine, Farmington, USA
| | | | - Mark A Burbridge
- Anesthesiology, Stanford University Medical Center, Stanford, USA
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Yee KOK, Yoon CK, Seman Z, Hong CK, Misron SNF, Lim CH. Ictal Electroencephalogram Visual Pattern Recognition of Seizure Adequacy During Electroconvulsive Therapy Treatment: A Step-by-Step Approach. Malays J Med Sci 2023; 30:83-89. [PMID: 37102040 PMCID: PMC10125233 DOI: 10.21315/mjms2023.30.2.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 09/09/2022] [Indexed: 04/28/2023] Open
Abstract
Background The NEURON (Neuropsychiatry and Neuromodulation Unit) electroconvulsive therapy electroencephalogram (ECT-EEG) Algorithmic Rating Scale (NEARS) is a step-by-step approach to ictal electroencephalogram visual pattern recognition of seizure adequacy based on recruitment, amplitude, symmetry, duration and degree of post-ictal suppression. The objectives of this clinical audit were to determine the degree of agreement on the NEARS operational criteria between two neuropsychiatrists, the reliability of electroconvulsive therapy practitioners' administration of NEARS during ECT procedures and the correlation of NEARS scores with Clinical Global Impression scale scores after each ECT treatment session. Methods Systematic random sampling was conducted. Even numbers of ictal tracings were selected for analysis from the total samples collected over 8 consecutive days of ECT overseen by a total of eight different ECT practitioners. Cohen's kappa coefficient was used to measure the inter-rater reliability of the two neuropsychiatrists and determine the level of agreement between NEARS scores and those of the ECT practitioners. The correlation using NEARS scores and post-ECT Clinical Global Impression scores was measured with Spearman's test. The significance level was set at P < 0.05. Results Cohen's kappa showed perfect agreement between the two neuropsychiatrists, at κ = 1.00 (SE = 0.001; P < 0.001), and strong agreement between NEARS scores of overall seizure adequacy and the scores interpreted by the ECT practitioners, at κ = 0.83 (95% CI: 0.66, 0.99; P < 0.001). Spearman's test showed a weak negative association between NEARS scores and post-ECT Clinical Global Impression scores (r = -0.018; P = 0.900). Conclusion NEARS may facilitate a brief, objectively reliable and practical assessment of ictal electroencephalogram quality. The scale is readily applicable by any trained ECT practitioner during an ongoing ECT procedure, especially when a prompt treatment decision is required.
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Affiliation(s)
- Kenny Ong Kheng Yee
- NEURON (Neuropsychiatry and Neuromodulation Unit), Department of Psychiatry and Mental Health, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Chee Kok Yoon
- NEURON (Neuropsychiatry and Neuromodulation Unit), Department of Psychiatry and Mental Health, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Zamtira Seman
- Sector for Biostatistics and Data Repository, National Institutes of Health, Selangor, Malaysia
| | - Chhoa Keng Hong
- NEURON (Neuropsychiatry and Neuromodulation Unit), Department of Psychiatry and Mental Health, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | | | - Chin Han Lim
- NEURON (Neuropsychiatry and Neuromodulation Unit), Department of Psychiatry and Mental Health, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
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Gurel SC, Ozden HC, Karahan S, Ayhan Y. The superiority of ketofol and etomidate against propofol or thiopental anesthesia for ECT. Asian J Psychiatr 2022; 72:103090. [PMID: 35390580 DOI: 10.1016/j.ajp.2022.103090] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/06/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Most anesthetic drugs used for electroconvulsive therapy (ECT) have dose-dependent anticonvulsive effects, counter-acting seizure induction, lowering seizure quality. However, a consummate drug for ECT anesthesia has not yet been established. Therefore, in this study, we aimed to investigate the effects of etomidate, thiopental, propofol and co-administration of ketamine-propofol (ketofol) on seizure quality and hemodynamic safety. METHODS Registries of 121 patients (1077 sessions) were retrospectively evaluated. The effects of anesthetics on ECT-related parameters (stimulation charge, central seizure duration, number of failed stimulation trials, mean arterial pressure, and peak heart rate) were analyzed via linear mixed-effects models. RESULTS Overall, the seizure duration decreased, and the stimulation charge increased in time with continuing sessions within a course of ECT. The decrease in seizure duration and the increase in required stimulation charge was significantly lower with etomidate and ketofol. Additionally, ketofol was significantly related to a lower number of failed stimulation trials compared to propofol. Ketofol and propofol use was associated with a significantly lower postictal mean arterial pressure. CONCLUSION Ketofol and etomidate were equivalently superior in the rate of decrease in seizure duration and the required elevation in stimulus charge, which would interpret into valuable clinical guidance, especially for "seizure resistant" patients, and their use may potentially lower ECT related cognitive side effects.
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Affiliation(s)
- S Can Gurel
- Department of Psychiatry, Hacettepe University Medical Faculty, Turkey; Faculty of Psychology and Neuroscience, Brain Stimulation and Cognition Research Group, Maastricht University, The Netherlands.
| | - Hayri Can Ozden
- Department of Psychiatry, Hacettepe University Medical Faculty, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Hacettepe University Medical Faculty, Turkey
| | - Yavuz Ayhan
- Department of Psychiatry, Hacettepe University Medical Faculty, Turkey
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Haji Seyed Javadi A, Najafian E, Kayalha H, Shafikhani AA. Evaluating Factors Affecting the Time Interval Between Propofol Injection and Induction of Electro-convulsion and Relationship Between These Factors and Duration of Convulsion. Anesth Pain Med 2021; 11:e117442. [PMID: 34692443 PMCID: PMC8520678 DOI: 10.5812/aapm.117442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background Current evidence on the effect of anesthetic-ECT time interval (AETI) is controversial. This study aimed to investigate the factors affecting the time interval between propofol injection and electro-convulsion induction and the relationship between these factors and the duration of convulsion. Methods In this study, 102 patients (616 sessions of ECT) were studied. Demographic and clinical data (age, gender, receiving or not receiving medications that affected the seizure threshold, the total number of ECT sessions, clinical severity of admission scores, clinical diagnosis, propofol dose, seizure duration, and AETI) were collected in special forms and analyzed by appropriate statistical methods. Results Sessions with long-term AETI had longer seizure time than sessions with short-term AETI (33.47 ± 8.46 vs. 28.68 ± 9.74, P value < 0.05). The duration of seizures was significantly longer in the group with long AETI in sessions 1, 2, and 4 than in the other group (P value < 0.05). There was a significant relationship between the duration of seizures and propofol dose, AETI, and receiving drugs effective in the seizure threshold (P value < 0.05). Conclusions The results showed that increasing AETI and injecting a lower dose of propofol to induce anesthesia would increase the duration of seizures. Also, taking medications that would affect the seizure threshold reduces the duration of seizures.
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Affiliation(s)
- Alireza Haji Seyed Javadi
- Clinical Research Development Unit, 22 Bahman Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
- Corresponding Author: Clinical Research Development Unit, 22 Bahman Hospital, Qazvin University of Medical Sciences, Qazvin, Iran. Tel: +98-2833565712, Fax: +98-2833565825,
| | - Ehsan Najafian
- Clinical Research Development Unit, 22 Bahman Hospital, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hamid Kayalha
- Department of Anesthesiology, Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Ali Akbar Shafikhani
- Department of Occupational Health Engineering, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hsieh ML, Lu YT, Lin CC, Lee CP. Comparison of the target-controlled infusion and the manual infusion of propofol anesthesia during electroconvulsive therapy: an open-label randomized controlled trial. BMC Psychiatry 2021; 21:71. [PMID: 33541306 PMCID: PMC7863537 DOI: 10.1186/s12888-021-03069-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Target-controlled infusion (TCI) of propofol is a well-established method of procedural sedation and has been used in Japan for anesthesia during electroconvulsive therapy (ECT). However, the usefulness of the TCI of propofol for ECT has yet to be determined. This study aimed to compare the TCI and manual infusion (MI) of propofol anesthesia during ECT. METHODS A total of forty psychiatric inpatients receiving bitemporal ECT were enrolled in the present study and randomized into the TCI group (N = 20) and the MI group (N = 20). Clinical Global Impression (CGI) and Montreal Cognitive Assessment (MoCA) scores were measured before and after ECT. The clinical outcomes, anesthesia-related variables, and ECT-related variables were compared between the two groups. Generalized estimating equations (GEEs) were used to model the comparison throughout the course of ECT. RESULTS A total of 36 subjects completed the present study, with 18 subjects in each group. Both the groups didn't significantly differ in the post-ECT changes in CGI and MoCA scores. However, concerning MoCA scores after 6 treatments of ECT, the MI group had improvement while the TCI group had deterioration. Compared with the MI group, the TCI group had higher doses of propofol, and longer procedural and recovery time. The TCI group seemed to have more robust seizures in the early course of ECT but less robust seizures in the later course of ECT compared with the MI group. CONCLUSIONS The present study does not support the use of TCI of propofol for anesthesia of ECT. TRIAL REGISTRATION (ClinicalTrials.gov): NCT03863925 . Registered March 5, 2019 - Retrospectively registered.
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Affiliation(s)
- Meng-Ling Hsieh
- grid.413801.f0000 0001 0711 0593Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan ,grid.145695.aSchool of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Ting Lu
- grid.413801.f0000 0001 0711 0593Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan ,grid.145695.aSchool of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chung Lin
- grid.413801.f0000 0001 0711 0593Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan ,grid.145695.aSchool of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chin-Pang Lee
- School of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Psychiatry, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
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Kim G, Moon E, Park JM, Lee BD, Lee YM, Jeong HJ, Kim SY, Lee K, Suh H. Various Psychiatric Manifestation in DiGeorge Syndrome (22q11.2 Deletion Syndrome): A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:458-462. [PMID: 32702226 PMCID: PMC7383002 DOI: 10.9758/cpn.2020.18.3.458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 11/20/2022]
Abstract
This case report aimed to describe various psychiatric manifestation and treatment course in a patient with DiGeorge syndrome. Psychiatric symptoms and treatment course in a female patient with DiGeorge syndrome were described. This patient showed psychotic symptoms, mood symptoms, and intellectual disability. As well as various psychiatric symptoms, treatment response and sensitivity of side effect by antipsychotics were different from typical characteristics in psychiatric disorders. This case suggests that the genetic defect in DiGeorge syndrome might have a great association with psychiatric problems and response of antipsychotics.
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Affiliation(s)
- Giok Kim
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Eunsoo Moon
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Korea.,Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Korea
| | - Je Min Park
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Korea.,Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Korea
| | - Byung Dae Lee
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Korea.,Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Korea
| | - Young Min Lee
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Korea.,Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Korea
| | - Hee Jeong Jeong
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Soo Yeon Kim
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Kangyoon Lee
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hwagyu Suh
- Department of Psychiatry, Medical Research Institute, Pusan National University Hospital, Busan, Korea
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Choi SH, Kang SG, Kim HY, Kim HY, Bae JN, Lee JS, Kim WH. Important Consideration in Choosing Antipsychotics in the Treatment of Patients with 22q11.2 Deletion Syndrome: Risk of Convulsion. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2020; 18:454-457. [PMID: 32702225 PMCID: PMC7383000 DOI: 10.9758/cpn.2020.18.3.454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/06/2018] [Accepted: 12/21/2018] [Indexed: 11/29/2022]
Abstract
The prevalence of epilepsy and psychosis in 22q11.2 deletion syndrome (22q11.2DS) is higher than in the general population. Recent study on adults with 22q11.2DS reported that the most common trigger for provoked seizures was the use of antipsychotics and antidepressants. In this paper, blonaserin was used because aripiprazole, quetiapine, paliperidone were not effective. The patient had convulsion on the fourth day of taking blonaserin. Neurological and cardiac examination was carried out, and lamotrigine was added at the advice of neurologist. Than the patient didn’t have any convulsions and the symptoms gradually improved. When treating patients with 22q11.2DS, the medicine should be chosen carefully, and the patient should be observed closely, paying attention to the possibility of convulsions.
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Affiliation(s)
- Seo-Hyun Choi
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Sang-Gu Kang
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Hee-Yeon Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Hye-Young Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Jae-Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Jung-Sub Lee
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
| | - Won-Hyoung Kim
- Department of Psychiatry, Inha University Hospital, Incheon, Korea
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