Seizure length and clinical outcome in electroconvulsive therapy using methohexital or thiopental

Rachel E. Dew, James N. Kimball, Peter B. Rosenquist, William Vaughn McCall

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Seizure duration is an extensively studied and controversial indicator of treatment quality in electroconvulsive therapy. Previous research comparing the effect of the barbiturate anesthetics methohexital and thiopental on seizure duration has yielded conflicting results. A recent period of unavailability of methohexital in the United States allowed for retrospective comparison of seizure length as well as clinical improvement in treatment using each agent. Retrospective review was made of 837 treatments administered to 97 patients between January 2, 2002, and May 31, 2003, examining anesthetic, seizure duration, and Global Assessment of Functioning (GAF) scores of inpatients at hospital admission and discharge. Analysis of variance of treatments 2-5 showed no significant effect for anesthetic on seizure duration. Analysis on a treatment-by-treatment basis revealed a marginally significant trend toward shorter EEG seizures in the thiopental group at the second treatment (50.5 ± 23.6 s vs. 61.1 ± 27.9 s; P = 0.07) and fifth treatment (41.7 ± 16.9 s vs. 51.8 ± 24.0 s; P = 0.07). A difference approaching statistical significance revealed shorter convulsion length in the thiopental group at treatment 5 (29.0 ± 12.3 s vs. 34.8 ± 12.3 s; P = 0.07). Comparison of GAF score improvement at hospital discharge revealed no significant difference (GAF increase 26.4 ± 9.4 for methohexital-treated patients vs. 24.8 ± 12.0 for thiopental-treated patients; t = 1.00, df = 82, P > 0.1). Trends approaching significance in treatments 2 and 5 revealed shorter seizures in the thiopental group. However, data on clinical recovery reveals no greater improvement in the methohexital group. Thus, this study calls further into question the premise that choice of barbiturate anesthetic may affect clinical efficacy.

Original languageEnglish (US)
Pages (from-to)16-18
Number of pages3
JournalJournal of ECT
Volume21
Issue number1
DOIs
StatePublished - Apr 19 2005

Fingerprint

Methohexital
Electroconvulsive Therapy
Thiopental
Seizures
Anesthetics
Therapeutics
Inpatients
Electroencephalography
Analysis of Variance

Keywords

  • Anesthetic
  • ECT
  • Methohexital
  • Thiopental

ASJC Scopus subject areas

  • Neuroscience (miscellaneous)
  • Psychiatry and Mental health

Cite this

Seizure length and clinical outcome in electroconvulsive therapy using methohexital or thiopental. / Dew, Rachel E.; Kimball, James N.; Rosenquist, Peter B.; McCall, William Vaughn.

In: Journal of ECT, Vol. 21, No. 1, 19.04.2005, p. 16-18.

Research output: Contribution to journalArticle

@article{31a1cf45703a484080a53a63a713405c,
title = "Seizure length and clinical outcome in electroconvulsive therapy using methohexital or thiopental",
abstract = "Seizure duration is an extensively studied and controversial indicator of treatment quality in electroconvulsive therapy. Previous research comparing the effect of the barbiturate anesthetics methohexital and thiopental on seizure duration has yielded conflicting results. A recent period of unavailability of methohexital in the United States allowed for retrospective comparison of seizure length as well as clinical improvement in treatment using each agent. Retrospective review was made of 837 treatments administered to 97 patients between January 2, 2002, and May 31, 2003, examining anesthetic, seizure duration, and Global Assessment of Functioning (GAF) scores of inpatients at hospital admission and discharge. Analysis of variance of treatments 2-5 showed no significant effect for anesthetic on seizure duration. Analysis on a treatment-by-treatment basis revealed a marginally significant trend toward shorter EEG seizures in the thiopental group at the second treatment (50.5 ± 23.6 s vs. 61.1 ± 27.9 s; P = 0.07) and fifth treatment (41.7 ± 16.9 s vs. 51.8 ± 24.0 s; P = 0.07). A difference approaching statistical significance revealed shorter convulsion length in the thiopental group at treatment 5 (29.0 ± 12.3 s vs. 34.8 ± 12.3 s; P = 0.07). Comparison of GAF score improvement at hospital discharge revealed no significant difference (GAF increase 26.4 ± 9.4 for methohexital-treated patients vs. 24.8 ± 12.0 for thiopental-treated patients; t = 1.00, df = 82, P > 0.1). Trends approaching significance in treatments 2 and 5 revealed shorter seizures in the thiopental group. However, data on clinical recovery reveals no greater improvement in the methohexital group. Thus, this study calls further into question the premise that choice of barbiturate anesthetic may affect clinical efficacy.",
keywords = "Anesthetic, ECT, Methohexital, Thiopental",
author = "Dew, {Rachel E.} and Kimball, {James N.} and Rosenquist, {Peter B.} and McCall, {William Vaughn}",
year = "2005",
month = "4",
day = "19",
doi = "10.1097/01.yct.0000154052.80893.f7",
language = "English (US)",
volume = "21",
pages = "16--18",
journal = "Journal of ECT",
issn = "1095-0680",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Seizure length and clinical outcome in electroconvulsive therapy using methohexital or thiopental

AU - Dew, Rachel E.

AU - Kimball, James N.

AU - Rosenquist, Peter B.

AU - McCall, William Vaughn

PY - 2005/4/19

Y1 - 2005/4/19

N2 - Seizure duration is an extensively studied and controversial indicator of treatment quality in electroconvulsive therapy. Previous research comparing the effect of the barbiturate anesthetics methohexital and thiopental on seizure duration has yielded conflicting results. A recent period of unavailability of methohexital in the United States allowed for retrospective comparison of seizure length as well as clinical improvement in treatment using each agent. Retrospective review was made of 837 treatments administered to 97 patients between January 2, 2002, and May 31, 2003, examining anesthetic, seizure duration, and Global Assessment of Functioning (GAF) scores of inpatients at hospital admission and discharge. Analysis of variance of treatments 2-5 showed no significant effect for anesthetic on seizure duration. Analysis on a treatment-by-treatment basis revealed a marginally significant trend toward shorter EEG seizures in the thiopental group at the second treatment (50.5 ± 23.6 s vs. 61.1 ± 27.9 s; P = 0.07) and fifth treatment (41.7 ± 16.9 s vs. 51.8 ± 24.0 s; P = 0.07). A difference approaching statistical significance revealed shorter convulsion length in the thiopental group at treatment 5 (29.0 ± 12.3 s vs. 34.8 ± 12.3 s; P = 0.07). Comparison of GAF score improvement at hospital discharge revealed no significant difference (GAF increase 26.4 ± 9.4 for methohexital-treated patients vs. 24.8 ± 12.0 for thiopental-treated patients; t = 1.00, df = 82, P > 0.1). Trends approaching significance in treatments 2 and 5 revealed shorter seizures in the thiopental group. However, data on clinical recovery reveals no greater improvement in the methohexital group. Thus, this study calls further into question the premise that choice of barbiturate anesthetic may affect clinical efficacy.

AB - Seizure duration is an extensively studied and controversial indicator of treatment quality in electroconvulsive therapy. Previous research comparing the effect of the barbiturate anesthetics methohexital and thiopental on seizure duration has yielded conflicting results. A recent period of unavailability of methohexital in the United States allowed for retrospective comparison of seizure length as well as clinical improvement in treatment using each agent. Retrospective review was made of 837 treatments administered to 97 patients between January 2, 2002, and May 31, 2003, examining anesthetic, seizure duration, and Global Assessment of Functioning (GAF) scores of inpatients at hospital admission and discharge. Analysis of variance of treatments 2-5 showed no significant effect for anesthetic on seizure duration. Analysis on a treatment-by-treatment basis revealed a marginally significant trend toward shorter EEG seizures in the thiopental group at the second treatment (50.5 ± 23.6 s vs. 61.1 ± 27.9 s; P = 0.07) and fifth treatment (41.7 ± 16.9 s vs. 51.8 ± 24.0 s; P = 0.07). A difference approaching statistical significance revealed shorter convulsion length in the thiopental group at treatment 5 (29.0 ± 12.3 s vs. 34.8 ± 12.3 s; P = 0.07). Comparison of GAF score improvement at hospital discharge revealed no significant difference (GAF increase 26.4 ± 9.4 for methohexital-treated patients vs. 24.8 ± 12.0 for thiopental-treated patients; t = 1.00, df = 82, P > 0.1). Trends approaching significance in treatments 2 and 5 revealed shorter seizures in the thiopental group. However, data on clinical recovery reveals no greater improvement in the methohexital group. Thus, this study calls further into question the premise that choice of barbiturate anesthetic may affect clinical efficacy.

KW - Anesthetic

KW - ECT

KW - Methohexital

KW - Thiopental

UR - http://www.scopus.com/inward/record.url?scp=16344365629&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=16344365629&partnerID=8YFLogxK

U2 - 10.1097/01.yct.0000154052.80893.f7

DO - 10.1097/01.yct.0000154052.80893.f7

M3 - Article

VL - 21

SP - 16

EP - 18

JO - Journal of ECT

JF - Journal of ECT

SN - 1095-0680

IS - 1

ER -