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© 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Objective

The postictal state is underrecognized in epilepsy. Animal models show improvement of postictal symptoms and cerebral perfusion with acetaminophen or nimodipine. We studied the effects of acetaminophen or nimodipine on postictal electroencephalographic (EEG) recovery, clinical reorientation, and hypoperfusion in patients with ECT‐induced seizures.

Methods

In this prospective clinical trial with three‐condition randomized crossover design, study interventions were administered orally 2 h before ECT sessions (1000 mg acetaminophen, 60 mg nimodipine, or a placebo condition). Primary outcome measure was the speed of postictal EEG recovery. Secondary outcomes were the extent of postictal EEG recovery, clinical reorientation time, and postictal cerebral blood flow as assessed by perfusion‐weighted MRI. Bayesian generalized mixed‐effects models were applied for analyses.

Results

We included 300 seizures, postictal EEGs, and reorientation time values, and 76 MRI perfusion measures from 33 patients (median age 53 years, 19 female). Pretreatment with acetaminophen or nimodipine was not associated with change in speed of EEG recovery compared to placebo (1.13 [95%CI 0.92, 1.40] and 1.07 [95%CI 0.87, 1.31], respectively), nor with the secondary outcomes. No patient reached full EEG recovery at 1 h post‐seizure, despite clinical recovery in 89%. Longer seizures were associated with slower EEG recovery and lower postictal perfusion. Nimodipine altered regional perfusion in the posterior cortex.

Interpretation

Pretreatment with acetaminophen or nimodipine did not alleviate symptoms and signs of the postictal state. Systematic study of the postictal state after ECT‐induced seizures is feasible.

Details

Title
Exploring postictal recovery with acetaminophen or nimodipine: A randomized‐controlled crossover trial
Author
Pottkämper, Julia C. M. 1   VIAFID ORCID Logo  ; Verdijk, Joey P. A. J. 2 ; Stuiver, Sven 2 ; Aalbregt, Eva 3 ; Doesschate, Freek 4 ; Verwijk, Esmée 5 ; Schmettow, Martin 6 ; Wingen, Guido A. 7 ; Putten, Michel J. A. M. 8 ; Hofmeijer, Jeannette 9 ; Waarde, Jeroen A. 10 

 Clinical Neurophysiology group, University of Twente, Enschede, The Netherlands, Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands, Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands, Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands 
 Clinical Neurophysiology group, University of Twente, Enschede, The Netherlands, Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands 
 Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands 
 Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands, Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands 
 Department of Medical Psychology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands, Department of Psychology, Amsterdam University, Amsterdam, The Netherlands 
 Department of Cognitive Psychology and Ergonomics, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, the Netherlands 
 Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands 
 Clinical Neurophysiology group, University of Twente, Enschede, The Netherlands, Department of Neurology and Clinical Neurophysiology, Medisch spectrum Twente, Enschede, The Netherlands 
 Clinical Neurophysiology group, University of Twente, Enschede, The Netherlands, Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands 
10  Department of Psychiatry, Rijnstate Hospital, Arnhem, The Netherlands 
Pages
2289-2300
Section
Research Article
Publication year
2024
Publication date
Sep 1, 2024
Publisher
John Wiley & Sons, Inc.
e-ISSN
23289503
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
3124075330
Copyright
© 2024. This work is published under http://creativecommons.org/licenses/by/4.0/ (the "License"). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.