Effect of quantitative consciousness index on seizure parameters during electroconvulsive therapy in patients with major depressive disorder

Table 1 Demographic data, Hamilton Depression Rating Scale score, Zung’s Self-rating Depression Scale score, Montreal Cognitive Assessment score, and cardiorespiratory findings of three groups of patients

Characteristics	Group 1: qCON 60-70	Group 2: qCON 50-60	Group 3: qCON40-50
Age, years	32.3 ± 14.2	33.9 ± 15.0	31.9 ± 13.6
Male	2/8	1/8	1/8
Weight, kg	55.6 ± 7.0	55.9 ± 13.6	57.8 ± 15.5
Height, cm	162.3 ± 9.1	162.1 ± 9.9	164.9 ± 5.9
Propofol dose, mg (IQR)	85.5 (72.0, 88.5)	87.0 (70.5, 100.5)	85.5 (66.0, 105.0)
Succinylcholine dose, mg (IQR)	57.0 (48.0, 59.0)	58.0 (47.0, 67.0)	57.0 (44.0, 70.0)
Interventions, median (IQR)	8 (7, 9)	8 (6.5, 10)	8 (7.5, 8)
Baseline HAMD-24 score	42.8 ± 4.4	41.3 ± 4.4	42.3 ± 4.0
HAMD-24 score after fourth ECT	21.0 ± 4.4	22.4 ± 5.9	27.9 ± 7.7
HAMD-24 score after full ECT course	12.3 ± 4.7	13.3 ± 5.1	17.0 ± 6.0
Baseline SDS score	69.2 ± 7.4	65.8 ± 6.7	67.8 ± 6.0
SDS score after fourth ECT	57.7 ± 7.9	56.1 ± 11.6	60.3 ± 5.3
SDS score after full ECT course	49.7 ± 3.9	49.7 ± 5.7	54.4 ± 5.4
Baseline MoCA score	24.8 ± 2.6	25.1 ± 2.9	24.9 ± 2.9
MoCA score after fourth ECT	22.6 ± 2.1	23.5 ± 3.3	22.6 ± 3.1
MoCA score after full ECT course	23.4 ± 1.7	24.4 ± 2.9	24.1 ± 2.5
Cardiorespiratory data
Baseline heart rate, bpm	89.0 ± 9.8	87.0 ± 16.8	84.3 ± 19.3
Baseline systolic blood pressure, mmHg	118.9 ± 14.1	113.5 ± 14.0	112.1 ± 11.3
Baseline diastolic blood pressure, mmHg	74.4 ± 8.8	74.3 ± 11.3	70.0 ± 7.1
Baseline peripheral oxygen saturation, %	96.8 ± 1.4	97.3 ± 1.2	97.3 ± 1.2

ECT: Electroconvulsive therapy; HAM-D: Hamilton Depression Rating Scale; SDS: Zung’s Self-rating Depression Scale; MoCA: Montreal Cognitive Assessment; qCON: Quantitative consciousness.

Table 2 Generalized linear mixed model examining effect of treatment, patient, and anesthesia factors on electroencephalography seizure parameters

Covariate/dependent	EEG endpoint (s)			ASEI (μV2)			PSI (%)			Mid-ictal amplitude (μV)			Coherence (%)			Maximum heart rate, (bpm)			Recovery time (min)
	Est	SE	P value	Est	SE	P value	Est	SE	P value	Est	SE	P value	Est	SE	P value	Est	SE	P value	Est	SE	P value
qCON	0.339	0.160	0.036a	34.150	140.526	0.808	0.057	0.095	0.553	0.531	0.232	0.023a	0.096	0.062	0.125	0.331	0.140	0.019a	-0.017	0.039	0.664
qNOX	-0.011	0.116	0.922	-2.927	116.196	0.980	0.162	0.079	0.042a	0.216	0.191	0.259	0.001	0.051	0.988	0.061	0.114	0.593	0.022	0.029	0.457
Age (years)	-0.597	0.213	0.006a	142.879	94.214	0.131	-0.079	0.063	0.211	-0.064	0.162	0.693	0.034	0.046	0.456	0.091	0.104	0.384	0.096	0.046	0.039a
ECT number	-	-	0.000a	-	-	0.000a	-	-	0.024a	-	-	0.418	-	-	0.158	-	-	0.128	-	-	0.266
Charge, mC	0.068	0.667	0.307	-32.539	30.452	0.287	0.014	0.020	0.491	0.032	0.052	0.545	-0.007	0.015	0.647	-0.024	0.034	0.483	0.002	0.015	0.888
Anesthetic-ECT time, interval (min)	0.157	0.048	0.001a	-17.207	43.983	0.696	0.072	0.030	0.018a	0.041	0.073	0.575	0.007	0.020	0.724	0.074	0.044	0.093	-0.001	0.012	0.922

^aP < 0.05.

Est: Estimate; SE: Standard error; EEG endpoint: Electroencephalograph seizure duration; ASEI: Average seizure energy index; PSI: Post-ictal suppression index; qCON: Quantitative consciousness; qNOX: Quantitative nociceptive; ECT: Electroconvulsive therapy.

Table 3 The effect of anesthesia depth on electroencephalography seizure parameters: Findings of generalized linear mixed model analyses

Characteristics (dependent variable)	F value	P value
Maximum heart rate	3.460	0.034a
EEG endpoint	3.326	0.038a
ASEI	0.236	0.790
PSI	7.041	0.001a
Mid-ictal amplitude	5.717	0.004a
Coherence	3.364	0.037a
Maximum systolic blood pressure	1.490	0.228
Maximum diastolic blood pressure	0.375	0.688
Recovery time after treatment	0.095	0.909

^aP < 0.05.

EEG endpoint: Electroencephalograph seizure duration; ASEI: Average seizure energy index; PSI: Post-ictal suppression index.

Table 4 Adverse events reported by participants during anesthesia recovery period: Findings of Fisher’s precision probability test, n (%)

Adverse event	Group 11	Group 22	Group 33	χ²	P value
Headache	5 (7.9)	7 (10.8)	4 (6.2)	0.926	0.629
Dizziness	3 (4.8)	6 (9.2)	3 (4.6)	1.404	0.603
Nausea/vomiting	3 (4.8)	6 (9.2)	4 (6.2)	1.041	0.677
Muscle soreness	6 (9.5)	5 (7.7)	4 (6.2)	0.508	0.776
Delirium	0 (0)	0 (0)	0 (0)	-	-
Total	11 (17.5)	12 (18.5)	10 (15.4)	7.292	0.274

¹Quantitative consciousness index 60-70.

²Quantitative consciousness index 50-60.

³Quantitative consciousness index 40-50.