Postictal Suppression and ECT Response: New Study From France

Out on PubMed, from researchers in France, is this study:

A Retrospective Study of Postictal Suppression during Electroconvulsive Therapy.

Moulier V, Guehl J, Evêque-Mourroux E, Quesada P, Rothärmel M.J Clin Med. 2022 Mar 5;11(5):1440. doi: 10.3390/jcm11051440.PMID: 35268529

The abstract is copied below:

Background: electroconvulsive therapy (ECT) is the most effective treatment in treatment-resistant depression (TRD), but its response remains partial. Identifying useful indicators to guide decision making for treatment and improve clinical response remains a major issue. The objective of the present retrospective study was to determine if clinical response-early (after 5 ECT sessions) or longer-term (after 12 ECT sessions)-was associated with postictal suppression during the first ECT course and/or with postictal suppression frequency during the whole ECT course.

Methods: in a retrospective study, the data of 42 patients suffering from treatment-resistant depression and receiving at least 5 ECT sessions were collected. Two sessions per week of bitemporal brief-pulse ECT sessions were administered to patients. Each of the electroencephalography (EEG) recordings were assessed to determine the presence of postictal suppression.

Results: the postictal suppression from the first ECT session predicted a better long-term clinical response (after 12 ECT sessions), but not early clinical response (after only 5 ECT sessions). The postictal suppression frequency was associated with neither the short- nor the long-term clinical response. In addition, postictal suppression and short-term cognitive performances were not associated.

Conclusions: this EEG indicator is clinically useful if it appears in the first ECT sessions, but it is no longer relevant in the following sessions.

Keywords: electroconvulsive therapy (ECT); electroencephalography (EEG); postictal suppression; treatment-resistant depression (TRD).

The article is here.

And from the text:









All studies of EEG parameters during ECT are interesting, and this one is no exception. But the methods are so primitive (visual yes/no determination of suppression, poorly controlled stimulus dosing, retrospective nature, smallish sample size) that these results can only be considered tentative. The recruitment of inhibitory brain mechanisms thought to be involved in seizure termination/postictal suppression is generally agreed to be a marker of seizure potency/efficacy, but, beyond that, we get into more theoretical territory. (Please see also: 
Is seizure termination a key? 
Sartorius A. Brain Stimul. 2021 Jul 28;14(5):1089-1090. doi: 10.1016/j.brs.2021.07.017. PMID: 34329796 , discussed in the blog on August 17, 2021).
A PubMed search of "postictal suppression electroconvulsive" returns nearly 100 citations, but a definitive study remains to be done; that would require a very large dataset, skilled EEG acquisition and sophisticated trial methodology.
I am hopeful that it could happen... 
All followers of the EEG ECT literature will want to read this paper in full, ~ 15 minutes.


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