Strength Symmetry Index: A measure of seizure adequacy in ECT

Seizure electroencephalography (EEG) was recorded from two channels-right (Rt) and left (Lt)-during bilateral electroconvulsive therapy (ECT) (n = 12) and unilateral ECT (n = 12). The EEG was also acquired into a microcomputer and was analyzed without knowledge of the clinical details. EEG recordings of both ECT procedures yielded seizures of comparable duration. The Strength Symmetry Index (SSI) was computed from the early- and midseizure phases using the fractal dimension of the EEG. The seizures of unilateral ECT were characterized by significantly smaller SSI in both phases. More unilateral than bilateral ECT seizures had a smaller than median SSI in both phases. The seizures also differed on other measures as reported in the literature. The findings indicate that SSI may be a potential measure of seizure adequacy that remains to be validated in future research

EEG seizure in bilateral ECT is different between low and high stimulus doses

Melancholic depressive patients referred for ECT were randomized to receive either low dose (n = 20) or high dose (n = 20) stimulus applied bifrontotemporally. The two stimulus groups were comparable on the clinical variables. The EEG seizure was recorded on two channels (right and left frontal), digitized, coded and analyzed offline without knowledge of ECT parameters. EEG seizure was of comparable duration in the two stimulus (high dose and low dose) groups. A new composite measure, Strength-Symmetry-Index (SSI), based on strength and symmetry of seizure EEG was computed using fractal geometry. The SSI of the early-seizure was higher in the high dose than in the low dose ECT group. In a stepwise, logistic regression model, this variable contributed to 65% with correct classification of high dose and low dose ECT seizures