Journal of Anesthesia

, Volume 32, Issue 6, pp 866–871 | Cite as

The relationship between seizure in electroconvulsive therapy and pupillary response using an automated pupilometer

  • Kazuhiro Shirozu
  • Keitaro Murayama
  • Yuji Karashima
  • Hidekazu Setoguchi
  • Tomofumi Miura
  • Sumio Hoka
Original Article



Seizure duration and morphology, postictal suppression, and sympathetic nervous system activation are all recommended as assessments of adequate seizure in electroconvulsive therapy (ECT). However, blood pressure and heart rate are not typically assessed as part of sympathetic nervous system activation because of the administration of anesthetic or cardiovascular agents during ECT. Although the pupils are known to reflect to the activity of autonomic nervous system and the degree of brain damage, previous studies have not examined the relationship between seizure of electroconvulsive therapy and pupillary response.


We conducted 98 sessions of ECT with 13 patients, divided into two groups according to seizure quality: (1) adequate or (2) inadequate. Pupillary light reflex [% constriction = (maximum resting pupil size {MAX} − minimum pupil size after light stimulation)/MAX × 100] was measured using a portable infrared quantitative pupilometer before anesthesia induction and immediately after electrical stimulation.


The number regarded as adequate was 67 times and as inadequate was 31 times. Maximum pupil size at the control and immediately after electrical stimulation was similar between the adequate and inadequate groups. Pupillary light reflex was similar at the control between both groups, but significantly smaller immediately after stimulation in the adequate group (2.5 ± 3.6%) compared with the inadequate group (10.6 ± 11.5%). Receiver operating characteristic curve analysis revealed that pupillary light reflex (> 5.5%) predicted adequate seizure.


The current findings suggest that pupillary constriction immediately after ECT could provide a helpful method for assessing the efficacy of ECT.


Electroconvulsive therapy Pupilometer Pupillary response 



Supported by departmental funding only.

Compliance with ethical standards

Conflict of interest

The authors declared that they have no conflict of interest.


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Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  • Kazuhiro Shirozu
    • 1
  • Keitaro Murayama
    • 2
  • Yuji Karashima
    • 3
  • Hidekazu Setoguchi
    • 4
  • Tomofumi Miura
    • 5
  • Sumio Hoka
    • 3
  1. 1.Department of Anesthesiology and Critical Care Medicine, Kyushu University HospitalKyushu UniversityFukuokaJapan
  2. 2.Department of NeuropsychiatryKyushu University HospitalFukuokaJapan
  3. 3.Department of Anesthesiology and Critical Care MedicineKyushu University Graduate School of MedicineFukuokaJapan
  4. 4.Operating RoomsKyushu University HospitalFukuokaJapan
  5. 5.Department of Neuro-PsychiatryKyushu University Graduate School of MedicineFukuokaJapan

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