Chapter 5. Adverse Effects - Prolonged Seizures

Written by Juli Lawrence

5.1.2. Prolonged Seizures

Each facility should have policies outlining the steps to be taken to terminate prolonged seizures and status epilepticus (see Section 11.9.4).

5.1.3 Prolonged Apnea

Resources for maintaining an airway for an extended period, including intubation, should be available in the treatment room (see Chapters 9 and 10).

Systemic Side Effects

Headache and nausea are the most common systemic side effects of ECT. Systemic side effects should be identified and symptomatic treatment considered.

5.3 Treatment Emergent Mania

Instances in which patients switch from depressive or affectively mixed states into hypomania or mania during a course of ECT should be identified, and a determination to continue or suspend further treatment with ECT.

5.4. Cognitive Dysfunction

a) Orientation and memory function should be assessed prior to ECT and periodically throughout the ECT course to detect and monitor the presence of ECT-related cognitive dysfunction (see Section 12.2.1 for details). This assessment should attend to patient self-reports of memory difficulty.

b) Based on the assessment of the severity of cognitive side effects, the physician administering ECT should take appropriate action. The contributions of medications, ECT technique, and spacing of treatments should be reviewed. Potential treatment modifications include changing from bilateral to right unilateral electrode placement, decreasing the intensity of electrical stimulation, increasing the time interval between treatments, and/or altering the dosage of medications, or, if necessary, terminating the treatment course.

Table 1. Treatment factors that may increase or decrease the severity of adverse cognitive side effects

next: Chapter 6. Pre-ECT Evaluation
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