The Journal of ECT

Skip Navigation LinksHome > March 2013 - Volume 29 - Issue 1 > Age-Based Seizure Threshold Determination
Journal of ECT:
doi: 10.1097/YCT.0b013e3182656e5d
Original Studies

Age-Based Seizure Threshold Determination

Swartz, Conrad M. PhD, MD*; Michael, Nikolaus MD

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Objective: The intent was to improve seizure threshold titration by decreasing stimuli number.

Method: An age-based method of titration for initial seizure threshold bilateral electroconvulsive therapy was constructed and used in 15 women and 9 men aged 35 to 80 years. Titration steps were one eighth, one fourth, three eighths, one half, five eighths, three fourths, 1, and 1.2 times age, expressed as “% Energy.”

Results: Male thresholds were a significantly (P < 0.05, t22 = 2.18) higher percentage of age (61.9%; SD, 32.6%) than female thresholds (41.2%; SD, 15.2%). Four women (27%) and 4 men (44%) showed seizure thresholds more than 50% of age. On average, women received 3.2 stimuli and men received 4.4 stimuli. No patient seized at one-eighth age. All patients who seized at one-fourth age were women and younger than 65 years.

Conclusions: For women younger than 65 years, these data suggest that titration starting at one-fourth age should require 1.8 stimuli on average. For older women, starting at three-eighths age should average 1.8 stimuli. For men, starting at three-eighths age should require 2.4 stimuli, but with steps at three fourths, 1, and 1.25 age titration should average 1.8 stimuli. Age-based dosing should succeed in women younger than 65 years at one-half age and older than 65 years at five-eighths age. For men, dosing at one-half age should succeed among one half and is a reasonable initial titration dose.

© 2013 Lippincott Williams & Wilkins, Inc.


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