Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and time
Abstract Background Most patients show temporary impairments in clinical orientation after electroconvulsive therapy (ECT)-induced seizures. It is unclear how postictal reorientation relates to electroencephalography (EEG) restoration. This relationship may provide additional measures to quantify po...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2024-01-01
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| Series: | European Psychiatry |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933824000105/type/journal_article |
| _version_ | 1797271119891267584 |
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| author | Sven Stuiver Julia C.M. Pottkämper Joey P.A.J. Verdijk Freek ten Doesschate Michel J.A.M. van Putten Jeannette Hofmeijer Jeroen A. van Waarde |
| author_facet | Sven Stuiver Julia C.M. Pottkämper Joey P.A.J. Verdijk Freek ten Doesschate Michel J.A.M. van Putten Jeannette Hofmeijer Jeroen A. van Waarde |
| author_sort | Sven Stuiver |
| collection | DOAJ |
| description | Abstract
Background
Most patients show temporary impairments in clinical orientation after electroconvulsive therapy (ECT)-induced seizures. It is unclear how postictal reorientation relates to electroencephalography (EEG) restoration. This relationship may provide additional measures to quantify postictal recovery and shed light on neurophysiological aspects of reorientation after ECT.
Methods
We analyzed prospectively collected clinical and continuous ictal and postictal EEG data from ECT patients. Postictal EEG restoration up to 1 h was estimated by the evolution of the normalized alpha–delta ratio (ADR). Times to reorientation in the cognitive domains of person, place, and time were assessed postictally. In each cognitive domain, a linear mixed model was fitted to investigate the relationships between time to reorientation and postictal EEG restoration.
Results
In total, 272 pairs of ictal-postictal EEG and reorientation times of 32 patients were included. In all domains, longer time to reorientation was associated with slower postictal EEG recovery. Longer seizure duration and postictal administration of midazolam were related to longer time to reorientation in all domains. At 1-hour post-seizure, most patients were clinically reoriented, while their EEG had only partly restored.
Conclusions
We show a relationship between postictal EEG restoration and clinical reorientation after ECT-induced seizures. EEG was more sensitive than reorientation time in all domains to detect postictal recovery beyond 1-hour post-seizure. Our findings indicate that clinical reorientation probably depends on gradual cortical synaptic recovery, with longer seizure duration leading to longer postsynaptic suppression after ECT seizures.
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| first_indexed | 2024-03-08T01:59:55Z |
| format | Article |
| id | doaj.art-8b62289c556646708b12e372d7df621d |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-04-25T02:15:06Z |
| publishDate | 2024-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-8b62289c556646708b12e372d7df621d2024-03-07T10:21:44ZengCambridge University PressEuropean Psychiatry0924-93381778-35852024-01-016710.1192/j.eurpsy.2024.10Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and timeSven Stuiver0https://orcid.org/0000-0002-5260-0820Julia C.M. Pottkämper1https://orcid.org/0000-0001-8049-9865Joey P.A.J. Verdijk2https://orcid.org/0000-0001-5415-3940Freek ten Doesschate3https://orcid.org/0000-0003-2236-3294Michel J.A.M. van Putten4Jeannette Hofmeijer5Jeroen A. van Waarde6https://orcid.org/0000-0001-6792-5727Technical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands Department of Psychiatry, Rijnstate Hospital, Arnhem, The NetherlandsTechnical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands Department of Neurology and Clinical Neurophysiology, Rijnstate Hospital, Arnhem, The NetherlandsTechnical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands Department of Psychiatry, Rijnstate Hospital, Arnhem, The NetherlandsDepartment of Psychiatry, Rijnstate Hospital, Arnhem, The NetherlandsTechnical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The NetherlandsTechnical Medical Centre, Faculty of Science and Technology, Clinical Neurophysiology, University of Twente, Enschede, The Netherlands Department of Neurology and Clinical Neurophysiology, Rijnstate Hospital, Arnhem, The NetherlandsDepartment of Psychiatry, Rijnstate Hospital, Arnhem, The NetherlandsAbstract Background Most patients show temporary impairments in clinical orientation after electroconvulsive therapy (ECT)-induced seizures. It is unclear how postictal reorientation relates to electroencephalography (EEG) restoration. This relationship may provide additional measures to quantify postictal recovery and shed light on neurophysiological aspects of reorientation after ECT. Methods We analyzed prospectively collected clinical and continuous ictal and postictal EEG data from ECT patients. Postictal EEG restoration up to 1 h was estimated by the evolution of the normalized alpha–delta ratio (ADR). Times to reorientation in the cognitive domains of person, place, and time were assessed postictally. In each cognitive domain, a linear mixed model was fitted to investigate the relationships between time to reorientation and postictal EEG restoration. Results In total, 272 pairs of ictal-postictal EEG and reorientation times of 32 patients were included. In all domains, longer time to reorientation was associated with slower postictal EEG recovery. Longer seizure duration and postictal administration of midazolam were related to longer time to reorientation in all domains. At 1-hour post-seizure, most patients were clinically reoriented, while their EEG had only partly restored. Conclusions We show a relationship between postictal EEG restoration and clinical reorientation after ECT-induced seizures. EEG was more sensitive than reorientation time in all domains to detect postictal recovery beyond 1-hour post-seizure. Our findings indicate that clinical reorientation probably depends on gradual cortical synaptic recovery, with longer seizure duration leading to longer postsynaptic suppression after ECT seizures. https://www.cambridge.org/core/product/identifier/S0924933824000105/type/journal_articleelectroconvulsive therapyelectroencephalogramrecovery of orientationconsciousnessmajor depression |
| spellingShingle | Sven Stuiver Julia C.M. Pottkämper Joey P.A.J. Verdijk Freek ten Doesschate Michel J.A.M. van Putten Jeannette Hofmeijer Jeroen A. van Waarde Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and time European Psychiatry electroconvulsive therapy electroencephalogram recovery of orientation consciousness major depression |
| title | Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and time |
| title_full | Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and time |
| title_fullStr | Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and time |
| title_full_unstemmed | Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and time |
| title_short | Restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person, place, and time |
| title_sort | restoration of postictal cortical activity after electroconvulsive therapy relates to recovery of orientation in person place and time |
| topic | electroconvulsive therapy electroencephalogram recovery of orientation consciousness major depression |
| url | https://www.cambridge.org/core/product/identifier/S0924933824000105/type/journal_article |
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