Despite recent advances in electroconvulsive therapy, clinicians still lack a reliable marker of treatment adequacy. Electroencephalographic (EEG) seizure morphology has been proposed as such a marker. However, the reliability of seizure ratings has not been assessed. We present the results of a study that examined how readily psychiatric residents could be taught to rate seizure morphology using a seizure regularity scale. We found that trainees could reliably rate seizure regularity and were particularly adept at discerning highly regular seizures from irregular ones. We believe that establishing reliable human scoring for electroconvulsive therapy seizure regularity justifies the position that human inspection of the ictal EEG should always complement computer analyses of seizure morphology.
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