ECT is the process of inducing a generalised seizure in a patient by the delivery of a trans-cranial electric stimulus. This is undertaken under general anaesthesia with muscle relation, which reduces the size of the motor component of the seizure and the likelihood of patient injury. Seizure length has often been used to predict outcome, or duration of therapy. This is mostly measured by timing of the motor seizure, patient variations as well as drug doses may have a large effect on this measure. This makes measurement of motor seizure unreliable.
Recent changes in equipment used to deliver the electric stimulus, include the incorporation of facilities for electroencephalographic (EEG) monitoring during ECT. Continuous EEG recording during ECT has shown the unreliability of motor activitiy in predicting seizure duration , as well as a wide variety of EEG morphology, in reponse to otherwise standardised electrical stimuli. It is felt, by leading psychiatrists in the field, that study of the EEG morphology is as relevant to patient outcome as ECG is to patients with cardiac morbidity.
As with the introduction of any technological solution to a clinical probelm, it brings with it drawbacks as well as advantages. In the case of Modified ECT, the problems include the need to train the treating physicians to use the machine safely, as well as to recognise the significance of EEG morphological variation.
The current method of training physicians who have not used MECT before, as well as new psychiatry trainees, is like an apprenticeship. The trainee reads papers, listens to didactic instruction in MECT and may even watch some sessions of MECT. This exposes the trainee to some variations in EEG, few applications of the electrodes, and may only expose them to a single episode of dose titration.
Difficult to manage and catastrophic critical events do occur rarely. This means that only a few psychiatrists can learn from or have exposure to these types of critical events.
ACTOR has been developed to aid training and research, thus improving the efficiency and safety of patient car.