Institutional members access full text with Ovid®

Share this article on:

Interrater Reliability of 2 Definitions of Seizure Adequacy in Electroconvulsive Therapy

Semple, David Michael MB ChB, MRCPsych*; Gunn, William MB ChB, MRCPsych*; Ellahi, Rabia MB ChB, MRCGP, DCCH, MRCPsych; Queirazza, Filippo MD, MRCPsych*

doi: 10.1097/YCT.0b013e31826905d0
Original Studies

Objectives Clear evidence of a generalized seizure is regarded as an essential component of a therapeutic electroconvulsive therapy (ECT) session. Recent criteria, in particular, the Royal College of Psychiatry ECT Handbook (2005), suggest that the pattern of electroencephalographic (EEG) seizure is more important than the duration of the seizure when assessing seizure adequacy. We examined the reliability of using EEG criteria compared to simple measures of seizure duration by reviewing 100 sample EEG printouts obtained during ECT sessions in a Scottish hospital ECT unit.

Methods The EEGs were independently assessed by 3 clinicians (a “control” ECT consultant, an experienced ECT therapist, and a less experienced trainee) blind to each other’s ratings.

Results While there was good interrater reliability for measures of seizure duration, kappa scores for EEG criteria were much better for the more than the less experienced rater (κ = 0.68 vs 0.50). Even greater differences were seen for individual components: polyspike activity (κ = 0.80 vs 0.55), spike and wave complexes (κ = 0.80 vs 0.38), and postictal suppression (κ = 0.63 vs 0.35).

Conclusions The implications of these finding are briefly discussed in the context of developing rational criteria for assessing ECT efficacy that rely upon the consistent and replicable delivery of standardized ECT techniques and consequent training needs of ECT practitioners.

From the *Hairmyres Hospital, East Kilbride, Glasgow, UK and †Dykebar Hospital, Paisley, UK.

Received for publication May 8, 2012; accepted July 10, 2012.

Reprints: David Michael Semple, MB ChB, MRCPsych, Hairmyres Hospital, Eaglesham Road, East Kilbride, Glasgow, G75 8RG, UK (e-mail:

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

© 2013 Lippincott Williams & Wilkins, Inc.