2004 issue 4

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Volume 13, issue 4

Review article

The overview of the methods of establishing the required electric currents used during electroconvulsive therapy

DANUTA PALIŃSKA1, Tomasz Sobów1, Iwona Kłoszewska1
1. Klinika Psychiatrii Wieku Podeszłego i Zaburzeń Psychotycznych Uniwersytetu Medycznego w Łodzi
Postępy Psychiatrii i Neurologii, 2004, 13 (4)
Keywords: electroconvulsive therapy, cognitive impairment, individual seizure threshold

Abstract

Aim. Electroconvulsive therapy (ECT) is an established treatment used in modern psychiatry. The technical aspects of ECT have been modernized in order to obtain two therapeutic objectives: high clinical efficacy and good tolerance. In this paper we present some methods to determine the electric energy dose needed for ECT.

Review. As measured by the EEG, the traditional criteria for the ECT efficacy are generalized tonic-clonic seizures lasting at least 25 seconds. Good tolerance to ECT requires the minimal risk of cognitive and consciousness impairments after the treatment. To achieve this goal, it is necessary to adjust the electrical dose to the individual seizure threshold measured prior to the treatment. The optimal electrical dose exceeds in small degree the level of the seizure threshold. Both small and high electrical dose usage results in shortening seizures and increasing the risk of cognitive impairments. Problems with determining electrical doses are due to the changes in the ECT individual seizure threshold, accompanying pharmacotherapy and the patient's personality trait. Recently, the criterion for the ECT efficacy is based on analyzing the EEG record during the seizure-like activity.

Conclusions. The new ECT method makes possible to determine the individual seizure threshold during the treatment and adjust the most effective electric energy dose for each patient. This technique is being applied in the modern ECT equipment.

Address for correspondence:
Dr Danuta Palińska,
Klinika Psychiatrii Wieku Podeszłego i Zaburzeń Psychotycznych
Uniwersytetu Medycznego,
ul. Czechosłowacka 8/10,
92-216 Łódź,
tel./fax: (42) 6783699