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Monitoring of seizures during electroconvulsive therapy by the ‘cuff’ method is still relevant today

Published online by Cambridge University Press:  02 January 2018

Prabhat Mahapatra*
Affiliation:
Bristol Central Community Learning Difficulties Team, New Friends Hall, Heath House Lane, Stapleton, Bristol BS16 1EQ
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Abstract

Type
The Columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © 2000, The Royal College of Psychiatrists

Sir: Jan Wise et al (Psychiatric Bulletin, August Reference Jan Wise, Mackie and Zamar2000, 24, 301) suggest that the use of the cuff method to ‘observe’ absent seizures during electroconvulsive therapy (ECT) should cease. They based their findings on the fact that there were no differences in the duration of seizures in the cuffed arm and the uncuffed arm. One fails to understand how this would happen if they were using an adequate dose of muscle relaxants. The methodology does not describe the nature or dose of neuromuscular blocking agent used. The authors also need to look at the possibility of a type-II error in view of the small number of ECT episodes included in the study.

It is worthwhile pointing out that the cuff method is not used to merely ‘observe’ absent seizures, but to monitor inadequate seizures as well as to detect status epilepticus, which can prove fatal if undetected. It is true that electroencephalogram (EEG) monitoring remains the standard, but resource implications mean that most centres in this country will have to manage with the cuff method. I was involved in a study where we found a strong correlation between duration of seizures as measured by the cuff method and by EEG monitoring. Several authors have replicated this finding.

The monitoring of seizures by the cuff method cannot be entirely dismissed and remains relevant to psychiatric practice today because of its cost-effectiveness.

References

Jan Wise, M. E., Mackie, F., Zamar, A. C., et al (2000) Investigation of the ‘cuff’ method for assessing seizure duration in electroconvulsive therapy. Psychiatric Bulletin, 24, 301.Google Scholar
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