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Age-Based Seizure Threshold Determination

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

doi: 10.1097/YCT.0b013e3182656e5d
Original Studies

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, t 22 = 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.

From the *Department of Psychiatry, Oregon Health and Science University, Portland, OR; and †Department of Psychiatry, Evangelische Stiftung Tannenhof, Remscheid, Germany, affiliated with the University of Muenster, Muenster, Germany.

Received for publication October 13, 2011; accepted June 18, 2012.

Reprints: Conrad M. Swartz, PhD, MD, 13023 NE Hwy 99 Suite 7-3, Vancouver, WA 98686-2767 (e-mail:

Disclosure: Dr. Swartz is a director of Somatics Co.

The authors have no conflicts of interest or financial disclosures to report.

© 2013 Lippincott Williams & Wilkins, Inc.