Abstract
Objectives: Seizure duration and morphology, postictal suppression, and sympathetic nervous system activation are all recommended as assessments of adequate seizure in electroconvulsive therapy (ECT). However, blood pressure and heart rate are not typically assessed as part of sympathetic nervous system activation because of the administration of anesthetic or cardiovascular agents during ECT. Although the pupils are known to reflect to the activity of autonomic nervous system and the degree of brain damage, previous studies have not examined the relationship between seizure of electroconvulsive therapy and pupillary response. Methods: We conducted 98 sessions of ECT with 13 patients, divided into two groups according to seizure quality: (1) adequate or (2) inadequate. Pupillary light reflex [% constriction = (maximum resting pupil size {MAX} − minimum pupil size after light stimulation)/MAX × 100] was measured using a portable infrared quantitative pupilometer before anesthesia induction and immediately after electrical stimulation. Results: The number regarded as adequate was 67 times and as inadequate was 31 times. Maximum pupil size at the control and immediately after electrical stimulation was similar between the adequate and inadequate groups. Pupillary light reflex was similar at the control between both groups, but significantly smaller immediately after stimulation in the adequate group (2.5 ± 3.6%) compared with the inadequate group (10.6 ± 11.5%). Receiver operating characteristic curve analysis revealed that pupillary light reflex (> 5.5%) predicted adequate seizure. Conclusions: The current findings suggest that pupillary constriction immediately after ECT could provide a helpful method for assessing the efficacy of ECT.
| Original language | English |
|---|---|
| Pages (from-to) | 866-871 |
| Number of pages | 6 |
| Journal | Journal of Anesthesia |
| Volume | 32 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Dec 1 2018 |
Fingerprint
All Science Journal Classification (ASJC) codes
- Anesthesiology and Pain Medicine
Cite this
The relationship between seizure in electroconvulsive therapy and pupillary response using an automated pupilometer. / Shirozu, Kazuhiro; Murayama, Keitaro; Karashima, Yuji; Setoguchi, Hidekazu; Miura, Tomofumi; Hoka, Sumio.
In: Journal of Anesthesia, Vol. 32, No. 6, 01.12.2018, p. 866-871.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The relationship between seizure in electroconvulsive therapy and pupillary response using an automated pupilometer
AU - Shirozu, Kazuhiro
AU - Murayama, Keitaro
AU - Karashima, Yuji
AU - Setoguchi, Hidekazu
AU - Miura, Tomofumi
AU - Hoka, Sumio
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Objectives: Seizure duration and morphology, postictal suppression, and sympathetic nervous system activation are all recommended as assessments of adequate seizure in electroconvulsive therapy (ECT). However, blood pressure and heart rate are not typically assessed as part of sympathetic nervous system activation because of the administration of anesthetic or cardiovascular agents during ECT. Although the pupils are known to reflect to the activity of autonomic nervous system and the degree of brain damage, previous studies have not examined the relationship between seizure of electroconvulsive therapy and pupillary response. Methods: We conducted 98 sessions of ECT with 13 patients, divided into two groups according to seizure quality: (1) adequate or (2) inadequate. Pupillary light reflex [% constriction = (maximum resting pupil size {MAX} − minimum pupil size after light stimulation)/MAX × 100] was measured using a portable infrared quantitative pupilometer before anesthesia induction and immediately after electrical stimulation. Results: The number regarded as adequate was 67 times and as inadequate was 31 times. Maximum pupil size at the control and immediately after electrical stimulation was similar between the adequate and inadequate groups. Pupillary light reflex was similar at the control between both groups, but significantly smaller immediately after stimulation in the adequate group (2.5 ± 3.6%) compared with the inadequate group (10.6 ± 11.5%). Receiver operating characteristic curve analysis revealed that pupillary light reflex (> 5.5%) predicted adequate seizure. Conclusions: The current findings suggest that pupillary constriction immediately after ECT could provide a helpful method for assessing the efficacy of ECT.
AB - Objectives: Seizure duration and morphology, postictal suppression, and sympathetic nervous system activation are all recommended as assessments of adequate seizure in electroconvulsive therapy (ECT). However, blood pressure and heart rate are not typically assessed as part of sympathetic nervous system activation because of the administration of anesthetic or cardiovascular agents during ECT. Although the pupils are known to reflect to the activity of autonomic nervous system and the degree of brain damage, previous studies have not examined the relationship between seizure of electroconvulsive therapy and pupillary response. Methods: We conducted 98 sessions of ECT with 13 patients, divided into two groups according to seizure quality: (1) adequate or (2) inadequate. Pupillary light reflex [% constriction = (maximum resting pupil size {MAX} − minimum pupil size after light stimulation)/MAX × 100] was measured using a portable infrared quantitative pupilometer before anesthesia induction and immediately after electrical stimulation. Results: The number regarded as adequate was 67 times and as inadequate was 31 times. Maximum pupil size at the control and immediately after electrical stimulation was similar between the adequate and inadequate groups. Pupillary light reflex was similar at the control between both groups, but significantly smaller immediately after stimulation in the adequate group (2.5 ± 3.6%) compared with the inadequate group (10.6 ± 11.5%). Receiver operating characteristic curve analysis revealed that pupillary light reflex (> 5.5%) predicted adequate seizure. Conclusions: The current findings suggest that pupillary constriction immediately after ECT could provide a helpful method for assessing the efficacy of ECT.
UR - http://www.scopus.com/inward/record.url?scp=85055560780&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055560780&partnerID=8YFLogxK
U2 - 10.1007/s00540-018-2566-9
DO - 10.1007/s00540-018-2566-9
M3 - Article
C2 - 30327871
AN - SCOPUS:85055560780
VL - 32
SP - 866
EP - 871
JO - Journal of Anesthesia
JF - Journal of Anesthesia
SN - 0913-8668
IS - 6
ER -