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Overlooking the obvious? Influence of electrolyte concentrations on seizure quality parameters in electroconvulsive therapy

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Abstract

Clinical response to electroconvulsive therapy (ECT) depends on eliciting a generalized seizure. Though there are multiple ictal and other parameters to assess seizure quality, factors that influence these parameters have only been identified to a limited extend in antecedent studies (e.g., stimulus dosage, age). In the context of ECT, electrolyte concentrations have hardly been investigated so far—although hyponatremia is one well-known clinical factor to increase the risk of spontaneous seizures. In 31 patients with unipolar or bipolar depressive disorder, blood concentrations of sodium (Na), potassium (K), and calcium (Ca) were measured immediately prior to repeated sessions of maintenance ECT. Generalized linear mixed models were used to analyze the influence of Na, K, and Ca on seven seizure quality parameters: postictal suppression index (PSI), maximum sustained coherence (MSC), midictal amplitude, average seizure energy index, seizure duration (EEG/motor), and peak heart rate. Results show a statistically significant relationship between the serum sodium level and MSC: in the model, a reduction of 1 mmol/l led to an increase in interhemispheric coherence of 0.678%. The further markers remained unaffected by changes in electrolyte concentrations. This finding provides first evidence that a lower blood concentration of sodium could enhance the quality of ECT-induced seizures in terms of higher interhemispheric coherence.

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Notes

  1. We point out that numerous studies found older patients to respond better to ECT treatment [13,14,15], but also to show inferior seizure quality parameters [10,11,12]. This may lead to treat them with higher stimulation doses (see introduction). Higher stimulation doses may then be connected to inferior seizure quality parameters (see Table 2). In this study, this relationship was not focused, but both age and stimulation dose were integrated in all GLMMs as covariates to control for a possible effect (please see statistical analyses for more details).

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Author notes

  1. Michael Belz and Isabel Methfessel declare to have equally contributed to the paper (shared the first authorship).

Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, von-Siebold-Strasse 5, 37075, Göttingen, Germany

    Michael Belz, Isabel Methfessel, Miriam Spang, Matthias Besse, Thorsten Folsche & David Zilles

  2. Department of Clinical Neurophysiology, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany

    Caspar Stephani

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  1. Michael Belz
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  2. Isabel Methfessel
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Correspondence to David Zilles.

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This study has been approved by the local ethics committee and has, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Belz, M., Methfessel, I., Spang, M. et al. Overlooking the obvious? Influence of electrolyte concentrations on seizure quality parameters in electroconvulsive therapy. Eur Arch Psychiatry Clin Neurosci 270, 263–269 (2020). https://doi.org/10.1007/s00406-019-01046-5

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  • DOI: https://doi.org/10.1007/s00406-019-01046-5

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