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Images in Clinical ECT

Images in Clinical Electroconvulsive Therapy

Portable 1-Channel Electroencephalogram Device as Adjunctive Seizure Monitoring

Gallucci-Neto, Jose MD, MSc; Bellini, Helena MD; Cretaz, Eric MD

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doi: 10.1097/YCT.0000000000000698
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Electroconvulsive therapy (ECT) is one of the most effective treatments for depression, acute mania, catatonia, and refractory psychosis.1 Modern ECT seizure duration monitoring includes measurement of the convulsive movement through the “cuff method” and measurement of electroencephalogram (EEG) activity. Modern ECT devices (MECTA and Somatics) include a recorder for EEG. Although both methods are highly correlated,2 EEG monitoring is necessary for the detection of prolonged seizures (seizures longer than 120 seconds).3

We report a case of bilateral ECT procedure using a MECTA spECTrum 4000Q device in a 43-year-old man receiving ECT for refractory schizophrenia. MECTA spECTrum 4000Q does not have EEG physiological monitoring; therefore, we decided to monitor EEG activity using a one-channel portable Brain SpikerBox bio amplifier device from Backyard Brains (Ann Arbor, Mich, backyardbrains.com4) connected to a MacBook laptop (Apple Inc, Cupertino, Calif) running SpikeRecorder software. We first set a baseline EEG record at rest for 2 minutes that showed a regular alpha activity. MECTA device parameters were set using pulse width of 1.0 ms, 120 Hz, train duration 6 seconds, and current at 800 mA with resulting charge of 1152 mC. Spikerbox electrodes were placed in a bifrontal position using 3M pads, corresponding to Fp1 and Fp2 electrodes in the classical 10 to 20 montage.

Electroencephalogram baseline and seizure monitoring using SpikerBox are shown in Figures 1 and 2. The ECT stimulus elicited a 52-second generalized tonic-clonic seizure with unequivocal epileptiform discharges on EEG.

Baseline EEG calibration and during ECT stimulus.
EEG activity during seizure onset and seizure termination.

Figures 1 and 2 show different phases of the EEG: baseline (alpha activity), during ECT stimulus, seizure activity (polyspike, theta and delta activity), and seizure termination (postictal silence).

The SpikerBox EEG equipment performed well during and after the procedure, apparently sustaining no damage from the ECT stimulus. It is noteworthy that the SpikerBox is a simple, low-cost monitor, which was not devised for use with ECT, and yet it proved to be an acceptable alternative to more expensive and more complex equipment usually used.

Our case report suggests that portable EEG devices are very easy to handle and can be extremely useful in ECT settings where there is no EEG available from specific MECTA or Thymatron models.


1. Prudic J, Sackeim HA, Devanand DP. Medication resistance and clinical response to electroconvulsive therapy. Psychiatry Res. 1990;31:287–296.
2. Fink M, Johnson L. Monitoring the duration of electroconvulsive therapy seizures: ‘cuff’ and EEG methods compared. Arch Gen Psychiatry. 1982;39:1189–1191.
3. Greenberg LB. Detection of prolonged seizures during electroconvulsive therapy: a comparison of electroencephalogram and cuff monitoring. Convuls Ther. 1985;1:32–37.
4. Dagda RK, Thalhauser RM, Dagda R, et al. Using crickets to introduce neurophysiology to early undergraduate students. J Undergrad Neurosci Educ. 2013;12:A66–A74.
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