A protocol to augment ECT seizure duration DOUGLASGEE,Senior House Officer in Psychiatry; and ANTHONYWHITE,Consultant Psychiatrist, County Hospital, Durham DH1 4ST

The presence of a generalised seizure is necessary, although not sufficient, for effective ECT. Awareness of this has led to a widespread practice of document ing not only the occurrence but also the duration of seizures; a minimum duration of 25 seconds has been suggested (Royal College of Psychiatrists, 1989).Yet even the most recent surveys of practice have shown that on most occasions when a seizure is brief or absent the treating doctor does nothing about it (Scott et al. 1989; Pippard, 1992). Various procedures have been recommended to enhance seizure duration (American Psychiatric Association, 1990). First, the technical aspects of the ECT application should be checked. Second, the concurrent use of medication or anaesthetic agents with anticonvulsant properties should be avoided. Third, the electrical stimulus delivered can be increased, a procedure known as stimulus dosing. Fourth, the seizure threshold can be lowered by con current administration of epileptogenic drugs. The use of caffeine in this respect has received recent interest (Coffey et al, 1987).These procedures can be, but seldom are, incorporated into a protocol to guide the treating doctor over action to take if a seizure is below a certain threshold duration. If the process of recording seizure duration is viewed as audit, the failure to make an intervention after finding a short seizure is a classic failure to com plete the audit cycle. We therefore undertook a local audit of seizure duration, firstly to examine current practice and secondly to examine the feasibility and effect of a protocol designed to enhance seizure duration.