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

Sir: Jan Wise et al (Psychiatric Bulletin, August 2000, 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.