Past Issues

Background: For electroconvulsive therapy (ECT) to work effectively, the induced seizure should be adequate. The key measures for seizure adequacy are observed muscle movement and the electroencephalographic (EEG) fi nding during the seizure. Methods: The authors reviewed all available literature on the topic and added personal experiences in writing this overview article.
Results: Even though most modern ECT devices are equipped with electroencephalography(EEG), electrocardiography (ECG), electromyography (EMG) or optical motion sensor (OMS), the observed seizure muscle movement is the simplest and a most reliable method for monitoring the seizure. EMG and OMS are high-tech methods of monitoring muscle movement, but the reliability can be compromised due to artifacts. EEG is routinely used for monitoring a seizure because only EEG can refl ect the actual physiological response in the brain and when muscle movement is obliterated by muscle relaxants during ECT, only EEG can accurately confi rm the occurrence of a seizure.
Conclusion: Modern ECT monitoring techniques can provide clinically useful information, but the clinician should also know the possible interference factors to be sure that the induced seizure is adequate to ensure the ECT effi cacy. Therefore, combining the EEG fi nding with the observed muscle movement with cuff technique is the best way to monitor the effi cacy of seizure during ECT.