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Dr Goffen is to be commended for describing an alternate way to monitor the duration of ECT-induced seizures. He suggests that the change in heart rate provides a valid index of seizure duration. As Dr Goffen did not provide data that the seizures had been monitored by means other than ECG, we recently added ECG monitoring to our treatments. We confirm that tachycardia is present when other measurements (BP and EEG) indicate the presence of a cerebral fit.However, we did not note the same precise duration of tachycardia. In one instance, the tachycardia persisted beyond the duration of the BP-monitored seizure. In this instance, we believe that the methohexital hydrochloride dose was inadequate, and the patient apparently experienced breathing distress, which may have been the basis for the extended tachycardia (and hypertension). In other patients, the duration of tachycardia was much shorter, and some patients did not have
Fink M, Johnson L. ECT Seizure Monitoring-Reply. Arch Gen Psychiatry. 1984;41(1):106-107. doi:10.1001/archpsyc.1984.01790120110017