Allan Scott is a consultant psychiatrist in general adult psychiatry and an honorary senior lecturer in the Andrew Duncan Clinic at the Royal Edinburgh Hospital (Morningside Terrace, Edinburgh EH10 5HF, UK. Email: Fiona.Morrison{at}lpct.scot.nhs.uk). He is a member of the Royal College of Psychiatrists Special Committee on ECT and is the editor of the second edition of The ECT Handbook (Royal College of Psychiatrists, 2005).
The purpose of this article is to update practitioners on the latest published research into the prevalence of prolonged cerebral seizure activity following electroconvulsive therapy (ECT). This research is drawing attention to the real practical challenges of recording and reading an electroencephalogram (EEG) tracing in the ECT clinic. In particular, determination of the seizure end-point is not always practicable and this poses a major problem in the detection and management of prolonged cerebral seizure activity. Some practical tips are suggested, and an update is given on the status of EEG monitoring in the assessment of seizure adequacy.