ECT, Serum Electrolytes and Seizure Quality: New Data From Germany, in JECT

Out on PubMed, from investigators in Germany, is this study:

No Effect of Serum Electrolyte Levels on Electroconvulsive Therapy Seizure Quality Parameters.

Karl S, Sartorius A, Aksay SS.J ECT. 2024 Mar 1;40(1):47-50. doi: 10.1097/YCT.0000000000000966.PMID: 38411578

The abstract is copied below:

Introduction: Seizure quality is considered to be associated with treatment outcomes of electroconvulsive therapy (ECT). A wide range of treatment parameters and patient characteristics are known to influence seizure quality. However, conflicting results exist for the role of serum electrolyte levels and seizure quality.

Methods: We retrospectively analyzed a total of 454 patients and a total of 2119 individual acute ECT sessions irrespective of diagnosis where a clinical evaluation of serum levels of sodium, potassium, and calcium took place routinely up to 2 days before the ECT session. To assess the impact of serum electrolyte levels on seizure quality parameters, we used mixed-effects linear regression analysis with Bonferroni correction for multiple testing.

Results: Serum sodium, potassium, and calcium levels were not associated with seizure quality markers after correcting the significance level for multiple testing. Younger age was consistently associated with higher postictal suppression, interhemispheric coherence, midictal amplitude, and peak heart rate. Lower dose was consistently associated with longer electroencephalogram and motor seizure duration.

Conclusions: Our results suggest that there is no clinically relevant effect of serum electrolyte levels on seizure quality, at least within clinically commonly observed ranges of serum electrolyte concentrations.


The paper is here.
And from the text:



This is a very nice study with a large sample size. The main conclusion, that serum sodium levels (mostly within the normal range) don't have much effect on seizure quality is useful to know.
The conclusions about age and stimulus dose are, perhaps, even more interesting. We know that the younger brain is more excitable, and that younger patients have longer seizures, particularly at the first treatment. As I have said before, it is hard for the field to accept that lower, not higher, stimulus dose is associated with longer seizures. We have more evidence here. I wonder what this dataset would show if the initial dose titration session were excluded from the analyses?
Also, while younger patients have "better," or more robust seizures, there is the well-proven association between older age and better antidepressant outcome with ECT. So, seizure quality, although very important, is not the whole story...

Kudos to our German colleagues for this very well presented and interesting study.


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