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Changes in Seizure Threshold Over the Course of Electroconvulsive Therapy Affect Therapeutic Response and Are Detected by Ictal EEG Ratings

Received April 28, 1997; revised July 15, 1997; accepted July 21, 1997. From the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina. Address correspondence to Dr. Krystal, Department of Psychiatry and Behavioral Sciences, Box #3309, Duke University Medical Center, Durham, North Carolina, 27710; e-mail: krystal{at}cs.duke.edu

Therapeutic effectiveness of electroconvulsive therapy is influenced by the degree to which the stimulus intensity exceeds the seizure threshold. However, the threshold rises variably over the treatment course, confounding maintenance of desired relative stimulus intensity. In 47 depressed patients, decreases in relative stimulus intensity between treatments 1 and 6 were associated with diminished therapeutic response at treatment 6 for unilateral (UL) ECT. A multivariate model including manual ratings of ictal EEG data predicted whether seizure threshold rose with 82% accuracy. The same EEG variables were also significantly related to therapeutic response. Thus, decreases in relative stimulus intensity over the ECT course affect the therapeutic potency of UL ECT. Further, ictal EEG indices have considerable potential for predicting such stimulus intensity changes and their effect on therapeutic outcome.

Key Words: Electroconvulsive Therapy • Seizure Threshold • Depression

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