@article{c9d4cc81b0614144b3749afb4ca93fcf,
title = "Postictal generalized electroencephalographic suppression following electroconvulsive therapy: Temporal characteristics and impact of anesthetic regimen",
abstract = "Objective: Postictal generalized electroencephalographic suppression (PGES) has been defined as electroencephalographic (EEG) activity of less than 10 microvolts following a generalized seizure. PGES is associated with an increased risk of sudden unexplained death in epilepsy, as well as treatment efficacy of electroconvulsive therapy (ECT). We investigated the impact of anesthetic on PGES expression and temporal characteristics. Methods: We recorded postictal EEG in 50 ECT sessions in 11 patients with treatment resistant depression (ClinicalTrials.gov NCT02761330). For each participant, repeated sessions included either ketamine or etomidate general anesthesia during ECT. An automated algorithm was employed to detect PGES within 5 minutes after seizure termination. Results: PGES was detected in 31/50 recordings, with intermittent epochs recurring up to five minutes after seizure termination. PGES total duration was greater following ketamine than etomidate anesthesia (p = 0.04). PGES expression declined loglinearly as a function of time (r = -0.89, p < 10-4). EEG amplitude during PGES did not vary linearly with time. Conclusions: PGES can occur intermittently for several minutes following seizure termination. Anesthetic effects should be considered when correlating PGES duration to clinical outcomes. Significance: Prolonged EEG monitoring several minutes following seizure termination may be necessary to fully evaluate the presence and total duration of PGES.",
keywords = "Electroconvulsive therapy (ECT), Major depressive disorder, Postictal generalized electroencephalographic suppression, Seizure, Sudden unexplained death in epilepsy",
author = "Hickman, {L. Brian} and Kafashan, {Mohammad Mehdi} and Labonte, {Alyssa K.} and Chan, {Courtney W.} and Huels, {Emma R.} and Guay, {Christian S.} and Guan, {Michael J.} and Ching, {Shi Nung} and Lenze, {Eric J.} and Farber, {Nuri B.} and Avidan, {Michael S.} and Hogan, {R. Edward} and Palanca, {Ben J.A.}",
note = "Funding Information: We would like to thank the RCC Collaborative Phase 2 group, particularly Drs. George Mashour and Max Kelz. This work was supported by the James S. McDonnell Foundation and the National Institutes of Health Clinical and Translational Science Award (CTSA) program [grant number TL1 TR002344]. The funding sources did not have any involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Funding Information: We would like to thank the RCC Collaborative Phase 2 group, particularly Drs. George Mashour and Max Kelz. This work was supported by the James S. McDonnell Foundation and the National Institutes of Health Clinical and Translational Science Award (CTSA) program [grant number TL1 TR002344]. The funding sources did not have any involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Conception and design of the project: LBH, ERH, SC, EJL, NBF, MSA, REH, BJP. Project execution/Data analysis: LBH, MMK, AKL, CWC, ERH, MG, NBF, MSA, REH, BJP. Manuscript preparation: LBH, MMK, AKL, CWC, ERH, CG, MG, SC, EJL, NBF, MSA, REH, BJP. Publisher Copyright: {\textcopyright} 2021 International Federation of Clinical Neurophysiology",
year = "2021",
month = apr,
doi = "10.1016/j.clinph.2020.12.018",
language = "English",
volume = "132",
pages = "977--983",
journal = "Clinical Neurophysiology",
issn = "1388-2457",
number = "4",
}