Zhao BS, Deng B, Chen QB, Li X, Yang Y, Min S. Effect of quantitative consciousness index on seizure parameters during electroconvulsive therapy in patients with major depressive disorder. World J Psychiatry 2024; 14(9): 1375-1385 [DOI: 10.5498/wjp.v14.i9.1375]
Corresponding Author of This Article
Su Min, MBBS, Professor, Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. ms89011068@163.com
Research Domain of This Article
Psychiatry
Article-Type of This Article
Randomized Clinical Trial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Psychiatry. Sep 19, 2024; 14(9): 1375-1385 Published online Sep 19, 2024. doi: 10.5498/wjp.v14.i9.1375
Effect of quantitative consciousness index on seizure parameters during electroconvulsive therapy in patients with major depressive disorder
Bang-Shu Zhao, Bi Deng, Qi-Bin Chen, Xiao Li, You Yang, Su Min
Bang-Shu Zhao, Qi-Bin Chen, Su Min, Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Bi Deng, You Yang, Department of Anesthesiology, The First Clinical College of Chongqing Medical University, Chongqing 400016, China
Xiao Li, Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Author contributions: Zhao BS prepared the manuscript for publication and contributed to the study design, data collection, and analysis; Deng B and Yang Y contributed to the statistical analysis and preparation of the tables and figures; Li X contributed to the electroshock therapy, psychiatric assessment, and electroencephalography analysis; Chen QB administered anesthesia in clinical practice; Min S contributed to the study design and analysis. All authors revised and approved the final version of the manuscript.
Supported bythe National Natural Science Foundation of China, No. 81873798 and No. 81901377; and Chongqing Science and Technology Bureau Under Grant, No. cstc2019jcyj-msxmX0839.
Institutional review board statement: The research was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University, batch number: 2023 Scientific Research Ethics (2023-052).
Clinical trial registration statement: The study was registered on the official website of clinical trials (https://clinicaltrials.gov, ID: NCT05900245).
Informed consent statement: All participants provided informed consent before participating in the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data used in this study can be obtained from the corresponding author upon request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Su Min, MBBS, Professor, Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, China. ms89011068@163.com
Received: July 15, 2024 Revised: August 18, 2024 Accepted: August 28, 2024 Published online: September 19, 2024 Processing time: 57 Days and 19.5 Hours
Abstract
BACKGROUND
Electroconvulsive therapy (ECT) is both an effective treatment for patients with major depressive disorder (MDD) and a noxious stimulus. Although some studies have explored the effect of sedation depth on seizure parameters in ECT, there is little research on the noxious stimulation response to ECT. In this study, we used two electroencephalography (EEG)-derived indices, the quantitative consciousness (qCON) index and quantitative nociceptive (qNOX) index, to monitor sedation, hypnosis, and noxious stimulation response in patients with MDD undergoing acute ECT.
AIM
To evaluate the effect of anesthesia depth based on the qCON and qNOX indices on seizure parameters.
METHODS
Patients with MDD (n = 24) underwent acute bilateral temporal ECT under propofol anesthesia. Before ECT, the patients were randomly divided into three groups according to qCON scores (qCON60-70, qCON50-60, and qCON40-50). Continuous qCON monitoring was performed 3 minutes before and during ECT, and the qCON, qNOX, vital signs, EEG seizure parameters, and complications during the recovery period were recorded. The 24-item Hamilton Rating Scale for Depression, Zung’s Self-rating Depression Scale, and Montreal Cognitive Assessment scores were evaluated before the first ECT session, after the fourth ECT session, and after the full course of ECT.
RESULTS
A total of 193 ECT sessions were performed on 24 participants. The qCON index significantly affected the EEG seizure duration, peak mid-ictal amplitude, and maximum heart rate during ECT (P < 0.05). The qNOX index significantly affected the post-ictal suppression index (P < 0.05). Age, number of ECT sessions, and anesthetic-ECT time intervals also had a significant effect on EEG seizure parameters (P < 0.05). However, there were no significant differences in complications, 24-item Hamilton Rating Scale for Depression scores, Zung’s Self-rating Depression Scale scores, or Montreal Cognitive Assessment scores among the three groups (P > 0.05).
CONCLUSION
Electrical stimulation at a qCON index of 60-70 resulted in better EEG seizure parameters without increasing complications in patients with MDD undergoing bilateral temporal ECT under propofol anesthesia.
Core Tip: Anesthesia depth based on quantitative consciousness index and quantitative nociceptive index affects electroconvulsive therapy (ECT) seizure parameters during acute ECT in patients with major depressive disorder. Electrical stimulation at a quantitative consciousness index of 60-70 will improve electroencephalography seizure parameters while not increasing complications. The quantitative nociceptive index had a significant effect on post-ictal suppression index, and patients with higher post-ictal suppression index may suffer from greater noxious stimulation during ECT. We should not only consider the effect of sedation depth on the quality of seizure but also the degree of noxious stimulation brought by the treatment technology itself during ECT.
