RISPERIDONE-INDUCED NEUROLEPTIC MALIGNANT SYNDROME : A CASE REPORT

A young male schizophrenic presented with neuroleptic malignant syndrome (NMS). Risperidone was the probable precipitating agent. Rigidity and elevated CPK levels poorly responded to bromocriptine, but showed good response to dantrolene. The role of specific treatment and the differential response of the symptom clusters are discussed

MERITS OF EEG MONITORING DURING ECT: A PROSPECTIVE STUDY ON 485 PATIENTS

Eliciting cerebral seizure during electroconvulsive therapy (ECT) is essential for therapeutic purposes. When it exceeds beyond 120 seconds (Freeman, 1995) i.e., prolonged, it adds to adverse effects of ECT. Estimating seizure duration using ‘cuff method’ alone has limitations. This study examined the merits of electroencephalographic (EEG) monitoring in routine ECT practice on a large representative sample. Modified ECT either unilateral or bilateral electrode placement, was administered to 485 patients under EEG monitoring at first ECT session. Ninety one (18.8%) patients had prolonged seizures of which only 59 would have been detected if ‘cuff method’ alone was used. Twenty nine (6%) patients had inadequate motor seizures but had adequate EEG seizure duration. Twenty five (5.2%) of them had no motor seizure and two such patients even had prolonged seizures. The prolonged seizure was unpredictable in majority. In conclusion, EEG monitoring during ECT is essential to detect both adequacy of cerebral seizure in patients having no or inadequate motor seizures and a/so to detect prolonged seizures

POTENTIATION OF LITHIUM WITH CARBAMAZEPINE IN ACUTE MANIA

In a 6 month prospective randomized open trial addition of 400 mgs. of carbamazepine per day to lithium carbonate was assessed. Although statistically non-significant, the trends suggest that use of carbamazepine hastens recovery and leads to less frequent use of emergency sedation without any increase in side effects

E. C. T. AND DRUG INDUCED PARKINSONISM

A cross-sectional evaluation of the presence of drug induced parkinsonian symptoms in hospitalized patients was done. Patients who had received two or more ECTs had lower scores of parkinsonism when compared to those who were net receiving ECT. Since the patient groups were comparable on parameters which would influence the occurrence and development of drug induced parkinsonism, the lowered scores in one group could be attributed to the effect of ECT

ICTAL RPP - A SUPPLEMENT TO CUFF METHOD IN DETECTING ECT-INDUCED CEREBRAL SEIZURE

During electroconvulsive therapy (ECT), occurrence of seizure must be confirmed. Cuff method, although simple and reliable, can sometimes miss an adequate EEG seizure. Predictable cardiovascular response occurs during ECT seizure. We examined if this can be an additional guide to detect cerebral seizure. In 164 modified ECT sessions, EEG and cuff methods were used for seizure monitoring. Heart rate (HR in beats per minute) and blood pressure (BP in mm of Hg) were recorded before (baseline) and 20 seconds after the stimulus (ictal). The rate pressure product (RPP=HR x systolic BP) was computed. The ECT sessions consisted of three groups, viz., adequate EEG and motor seizure (n=126), adequate EEG but not motor seizure (n=21) and neither EEG nor motor seizure adequate (n=17). Significant elevation of RPP occurred from baseline to ′ictal′ recording and this was different between the three groups. Ictal RPP did not differ between groups with or without adequate motor seizure if EEG seizure was adequate. The group with no adequate EEG or motor seizure had the least ′ictal′ RPP. Findings suggest that RPP response can be an additional clinical measure to detect seizures during ECT

SEIZURE DURATION ESTIMATES FROM SINGLE CHANNEL EEG RECORD: A METHODOLOGICAL REPORT

Seizure duration was estimated using a single channel EEG recording during ECT. Seizure endpoint was defined as the point of last spike. Three psychiatrists independently rated forty seven EEG records. Seizure endpoint could be reliably identified. The reliability coefficient between three raters was 0. 92, indicating high agreement among raters. Modal difference between any pair of raters as well as all three was 0.5 second or less. Operational definition of seizure endpoint improves the reliability of identifying the same and hence estimation of seizure duration from even a single channel EEG trace

LIMITATIONS OF MOTOR SEIZURE MONITORING IN ECT

Seizures were monitored using both cuff method and EEG, during the first ECT session in 158 consecutive patients. All developed adequate EEG seizures (≥25 seconds). Twelve patients (8%) did not develop adequate motor seizures (15 seconds), of whom ten had no convulsive response. EEG seizure duration was less than 120 seconds in 117 patients (Group-A) and 120 or more seconds (prolonged) in the remaining 37 patients (Group-B). Adequate but not prolonged motor seizure (15-89 seconds) occurred in 111 patients in group A and 18 patients in group B. Motor seizure of 90 or more seconds (prolonged seizure) occurred in four patients in group A and 13 patients in group B. Based on the motor seizure criterion, 60% (18/31) of patients with prolonged EEG seizure were missed. The motor and EEG seizure durations correlated significantly in both groups. The correlation coefficient in group A was 0.78 (p< 0.01), which was significantly larger (Fisher's ‘Z’ transformation test, t=3.12, p< 0.01) than that in group B (0.37; p< 0.05). Out of the total 158 patients, motor seizure monitoring alone did not correctly classify 21.4% of ECT seizure. This could have resulted in either unnecessary re-stimulation or failure to detect prolonged seizure. The findings suggest that in ECT motor seizure monitoring alone is unsatisfactory and therefore the need for EEG seizure monitoring