How does seizure duration affect the efficacy of electroconvulsive therapy (ECT)?

Updated: Sep 24, 2019
  • Author: Mehul V Mankad, MD; Chief Editor: Dennis M Popeo, MD  more...
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Motor seizure duration (i.e., witnessed seizure activity) has little bearing on efficacy of ECT. Nevertheless, if the seizure duration is less than 15 seconds in motor and EEG manifestations, the seizure was very likely limited by insufficient electrical stimulation. [1]

The EEG is used to confirm total seizure activity and to document seizure duration. [42]  Motor seizure duration can be difficulty to ascertain during the modern ECT procedure due to the use of neuromuscular blockade (succinylcholine or nondepolarizing blockers). Therefore, motor seziure activity can be monitored using the "cuff technique," in which the circulation of the neuromuscular blocking agent is restricted from the hand or foot via a temporary tourniquet. This restriction of blood flow allows visual or instrumented observation of motor activity to confirm the presence of a seizure. [1, 42]  Such redundancy can be useful in the rare event of EEG failure during ECT.

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