Seizure threshold in electroconvulsive therapy. Effects of sex, age, electrode placement, and number of treatments.

@article{Sackeim1987SeizureTI,
  title={Seizure threshold in electroconvulsive therapy. Effects of sex, age, electrode placement, and number of treatments.},
  author={Harold A. Sackeim and Paolo Decina and Isak Prohovnik and Sidney Malitz},
  journal={Archives of general psychiatry},
  year={1987},
  volume={44 4},
  pages={
          355-60
        }
}
In a random-assignment trial to unilateral right and bilateral electrode placements, electroconvulsive therapy (ECT) stimulus intensity was titrated to just above seizure threshold for each of 52 depressed patients. Seizure threshold was quantified in units of charge. There was a 12-fold range in the minimum electrical intensity necessary to produce seizure. Sex, age, electrode placement, and the cumulative number of treatments were each associated with seizure threshold. Bilateral ECT had both… 
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TLDR
Sleep deprivation is an effective and safe technique used to lower the seizure threshold of ECT and to obtain an adequate seizure time without increasing the energy applied.
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TLDR
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 ECT, and a multivariate model including manual ratings of ictal EEG data predicted whether seizure threshold rose with 82% accuracy.
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