The study of maximum electromyogram of masseter muscle before and during modified electroconvulsive therapy in psychiatric patients
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Abstract
Background: Electroconvulsive therapy (ECT) is generally used to treat various severe and treatment resistant psychiatric disorders. Nowadays modified ECT is used, injury to teeth and other oral structure remain a risk in ECT despite the use of muscle relaxants due to the electrodes are placed on the temporal, quite close to the masseter muscle. The use of a bite guard is essential to prevent dental and soft tissue injuries; however, limited evidence exists regarding electromyogram (EMG) of the masseter muscle before and during modified ECT.
Objectives: To compare the maximum EMG of the masseter muscle under three conditions: 1) maximal clenching without a bite guard, 2) maximal clenching with a bite guard, and 3) during modified ECT with anesthesia, muscle relaxants and a bite guard and to evaluate post procedural oral complications.
Materials and Methods: This cross-sectional study included 40 psychiatric inpatients who undergoing modified ECT at Suanprung Psychiatric Hospital. Surface EMG signals of the masseter muscle were recorded using the Thymatron® System IV (Somatics LLC, USA) under the three conditions: before anesthesia without a bite guard (NB), before anesthesia with a bite guard (B), and during ECT with anesthesia, muscle relaxants and a bite guard (ECT). Differences among conditions were analyzed using repeated measures ANOVA, and independent samples t-tests were used to compare EMG values between groups (<5,451.1 μV vs ≥5,451.1 μV). Significance was set at p<0.05. Post procedural oral examinations were performed to identify any trauma or soft-tissue injuries.
Results: All 40 participants completed the study (mean age 35.63±13.17 years). Schizophrenia was the most prevalent diagnosis (45%), and 67.5% of patients were classified as ASA Class II. The maximum EMG amplitude during ECT was significantly higher than in the NB and B conditions (p<0.001). No significant differences in EMG amplitude were found between the NB and B conditions (p>0.05). Across all participants, EMG values differed significantly among all three conditions (p<0.001). Notably, no oral complications were observed with the use of the newly designed silicone bite guard.
Conclusion: Modified ECT induces significantly higher masseter muscle EMG activity approximately 15-fold greater than pre-ECT clenching. The use of newly designed silicone bite guard effectively prevents oral injury during ECT, supporting its routine clinical application to enhance patient safety and minimize oral complications.
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Personal views expressed by the contributors in their articles are not necessarily those of the Journal of Associated Medical Sciences, Faculty of Associated Medical Sciences, Chiang Mai University.
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