Monitoring the Seizure Efficacy during Electroconvulsive Therapy

電痙攣治療時痙攣效度之評估

10.29478/TJP.200903.0002

李文貴(Wen-Kuei Lee)；張信義(Sidney S. Chang)

電痙攣治療 ； 腦電波 ； 肌電圖 ； 脈壓帶技術 ； ECT ； EEG ； EMG ； cuff technique

台灣精神醫學

23卷1期（2009 / 03 / 01）

4 - 13

英文

當精神科醫師執行電痙攣治療時，誘導痙攣效度的判別與測量是必備的重要評量，其主要的評估方式可藉由肌肉反應及腦電波監測。雖然目前的電痙攣治療儀大都具有腦電波、心電圖、肌電圖或光學肌肉運動感應器等設備，但是「目測肌肉痙攣反應」仍是最簡單可靠的效度判別方式。監測肌肉痙攣反應可利用壓脈帶技術、肌電圖或光學肌肉運動感應器等方式來加以測量。另外，執行電痙攣治療時腦電波的監測乃屬常規測量項目，因為只有它才能反應出實際的大腦電生 理變化，而且萬一電痙攣治療誘導出的痙攣時間過長或未出現明顯的肌肉痙攣反應時，唯有靠腦電波才得以判別。無論如何，臨床上科學化的監測器確實提供許多寶貴資訊，得以讓我們思考如何提高痙攣的品質及效率，但存在許多干擾因素卻使它們的準確度受到影響，這亦是醫師在操作與判讀資料時所不可忽略的。因此，合併腦電波及應用脈壓帶技術之目測肌肉痙攣反應是電痙攣治療時判別痙攣效度最好的方法。

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) finding 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 reflect the actual physiological response in the brain and when muscle movement is obliterated by muscle relaxants during ECT, only EEG can accurately confirm 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 efficacy. Therefore, combining the EEG finding with the observed muscle movement with cuff technique is the best way to monitor the efficacy of seizure during ECT.

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1. Tien-Wei Hsu,Chih-Chuan Pan,Chen-Hsiu Chen,Cheng-Ho Chang(2020)。Add-on Subanesthetic Ketamine in Electroconvulsive Therapy: A Case Report of a Patient with Bipolar Depression。臺灣精神醫學，34(2)，94-95。