Somatics

The Thymatron® System IV has just become the first ECT device in history to feature an Anesthesia Depth Monitor. The recent unavailability of the anesthetic Brevital© (methohexital) has required many doctors to switch to other less-familiar agents, including especially propofol, whose biphasic action and seizure-shortening properties require special care in its use.

The new Anesthesia Depth Monitor provides a continuous front-panel display of your choice of 3 measures shown to correlate highly with anesthesia depth and with the Bispectral Index© (BIS©): 95% Spectral Edge Frequency (SEF-95), relative Delta power (% Delta), and Median Frequency (MF). Although these measures are presently available only on OR monitors costing in the range of US$10-20,000 they are now included with the Thymatron® System IV at no additional cost (upgrades to existing Thymatron® System IV units will also be made available, price to be announced).

The Thymatron® System IV now includes new software that lets you use a Palm© pocket-size computer (not included) to enter clinical patient information, store treatment data--including digital EEG analysis results--for up to 40 ECTs, and transfer all data to other computers at your convenience. There's no need to bring a bulky or costly computer to the ECT room or leave it there overnight: You can use the pocket-sized Palm© computer.

Allows you to monitor EEG1, EEG2, EKG, and EMG (or, choose 4 channels of EEG), plus 2 derived channels: digital heart rate and anesthesia depth index, while providing hard-copy documentation for the patient's chart.

Lets you select all the traditional Thymatron® functions plus important new ones, including an Ultra-brief (0.25 msec) pulse and programs that automatically set the most effective combination of stimulus parameters at any stimulus dose you have selected.

Pulsewidth and frequency settings to 0.25 msec and 20 Hz allow you to deliver stimuli up to 8 seconds long, to optimize treatment in accordance with research showing greater efficacy of short-pulsewidth, low-frequency, extended-duration stimuli (Isenberg et al, 1996; Chanpattana, 2001).

Now includes, in addition to the familiar Thymatron® DGx measures, your choice of the following new measures unique to the Thymatron® System IV (U.S. pat. #5,871,517):

Employs Power Spectral Analysis (FFT) to process and store up to 10 minutes of digitized EEG for the special features described here. You can send this data to any IBM PC-compatible or Palm computer via a rear-panel serial port for further comprehensive EEG analysis.

The Thymatron® System IV has all the functions of a sophisticated 4-CHANNEL DIGITAL EEG MACHINE with frequency, coherence, asymmetry, and power spectral analytic programs. These allow you to record and analyze EEGs in your ECT patients between treatments to measure ECT-induced frontal EEG slowing and other EEG manifestations reported to reflect treatment impact and efficacy (Fink & Kahn, 1957; Roemer et al, 1990-91; Sackeim et al, 1996).

Because each ECT treatment session is STORED IN MEMORY, you can retrieve it if you run out of paper during a treatment -- just slip in another roll after the treatment and press a button for a complete printout.

Prevents the patient from receiving an excessive electrical dose regardless of the operation of the regular circuits.

Unlike simple movement detectors, the Thymatron® System IV's EMG can measure seizure muscle activity that is not visible to the naked eye, and which typically continues substantially longer than visible movements (Couture et al, 1988).

Setting the Thymatron® System IV according to the patient's age facilitates easy selection of a stimulus charge for unilateral, bitemporal, or bifrontal ECT that is in the preferred range (Beale et al, 1994; Petrides & Fink, 1996).

Because the special computer-automated programs of the Thymatron® System IV are stored on REPLACEABLE MICROCHIPS, future system updates (there have been 4 already) can easily be accomplished via chip replacement.

The PATENTED Postictal Suppression Index reports the degree of EEG flattening immediately following the seizure, which has been reported to correlate with clinical efficacy (Nobler et al, 1993; Krystal & Weiner, 1994; Krystal et al, 1995; Krystal, 1998; Suppes et al, 1996; Petrides et al, 2000; Perera et al, 2002).

A new, improved Average Seizure Energy Index measures a dimension of the seizure -- its intensity -- that is not reflected in seizure duration (Nobler et al, 1993, 2000; Krystal & Weiner, 1994; Krystal et al, 1995; Suppes et al, 1996; Krystal, 1999; Perera et al, 2002).

The Thymatron® System IV measures the EEG, EMG, and EKG, and automatically prints the corresponding seizure duration estimates with precision and reliability Larson, Swartz and Abrams, 1984; Swartz et al, 1994; Krystal et al, 1995).

Also provides continuous EEG monitoring even if the recording paper runs out. It correlates highly with the visual EEG and keeps you constantly aware of the progress of the EEG seizure without having to watch the recording (Swartz & Abrams, 1986).

Because longer seizures generate more cognitive side-effects, may clinicians prefer to terminate seizures that exceed 120 to 180 seconds on the EEG (Abrams, 2002). To advise the clinician that this point has been reached, the Thymatron® System IV provides an intermittent click tone when a user-selected interval has elapsed after the stimulus and monitoring has not been terminated.

Is facilitated with the Thymatron® System IV using a simple method-of-limits procedure (McCall et al, 1993; Rasmussen et al, 1994).

Current:	0.9 A constant, isolated from line current
Frequency:	10 to 70 Hz in 10 Hz increments (to 140 Hz for 0.25 ms pulse)
Pulsewidth:	0.25 to 1.5 ms in 0.25 ms increments
Duration:	0.14 to 8.0 s in increments of equal charge
Maximum:	504 mC (99.4 J @ 220 ohm); 1008 mC (188.8 J @220 ohm) with double-dose option (where available)

user-selectable gain positions for EEG channels (10, 20, 50, 100, 200, 500, and 2000 µV/cm) and EMG/ECG channels (50, 100, 250, 500, 1000, 2500, 5000 and 10,000 µV/cm)

100-130 volts A.C., 60 Hz, single phase. 100 VA./220-240 volts, 50/60 Hz switchable.

New: Safe, Easy-to-Use, Disposable Mouth Protector for ECT

Introducing the Ventil-A™ single-use mouth protector for ECT (US patent 6,039,046), the natural complement to modern ECT.

Unlike skimpy cardboard-and-foam products that lack an air channel and cover only a few molars, the Ventil-A™’s thick 100% closed-cell foam construction (contains no cardboard) protects all the teeth. (And, even though the Ventil-A is made of premium material, it costs 40% less than the cardboard-and-foam product.)

The unique design with internal non-collapsible air channel allows free flow of oxygen and fits under any anesthesia mask—no other disposable does this.

Its dimensions are based on measurements of dozens of dental impressions of men and women of all ages—we guarantee it to fit >98% of adults.

Its one-piece design provides dimensional stability, ensuring reliable application without slippage; its looped end facilitates easy insertion and removal.

As with Somatics’ Thymapad™ disposable stimulus electrodes (more than one million sold), the Ventil-A™ mouth protector saves the time and expense of washing and sterilization, and eliminates the risk of cross-infection that occurs with re-usable products.

Somatics' patented adherent stimulus electrodes for bilateral or unilateral ECT remain exactly where applied without slipping or sliding. No exposed metal surfaces to give accidental shocks; single-use design prevents contamination and cross-infection. Used on over 70,000 patients since 1989.

The good news for MECTA users is that Thymapads™ are now available for use with all MECTA machines. For almost a decade hundreds of users of MECTA machines have asked us to configure our patented Thymapad™ adherent stimulus electrodes for use with their equipment. Now, we are pleased to announce the availability of Thymapads™ that fit ALL Mecta stimulus cables, including the Spectrum's cables and have the correct impedance needed to pass the "self-test" procedure without requiring an "override".

In 2 sizes to fit all patients, Somatics' uniquely designed autoclavable rubber MouthGuard™ oral protectors with integral airway provide the thickness and elasticity to prevent tooth fracture or tongue bite. Lifetime warranty against cracking or crumbling. Latex-free.

Sterilization Information for Somatics MouthGuards™:

Easy and quick to use, "the pregelled electrodes provided in the Thymatron® DG Starter kit...reduce preparation time" (Convulsive Therapy 2:53, 1986), compared to metal electrodes and ordinary disposable paper EEG electrodes.

Their small size facilitates bifrontal or fronto-mastoid application without interfering with treatment electrode placement.

Ideal for recording EEG, EKG, and EMG, they are conveniently packaged 5 per strip -- just right for all monitoring configurations (one channel each of EEG and EKG or EMG, plus ground). Instantly adherent, they will remain in place throughout the seizure.

This hand-held, solid state, peripheral nerve stimulator weighs only 7 oz. It applies a pulsed 0.2 msec square-wave stimulus through surface electrodes to precisely determine the point at which a safe degree of succinylcholine-induced muscle relaxation has been achieved. The operator has the option of selecting continuous (tetanus) or intermittent (twitch) stimulus modes. Battery powered (9 volt alkaline), it comes in a soft carrying case that clips to a pocket or belt. 2.4"x1.0"x3.8"

Device malfunction can cause ineffective ECT treatments or excessive side-effects. Now you can check your ECT device yourself with Somatics’ easy-to-use, patented EctoBrain™ II, which performs the same output check professional engineers use. A single button press instantly tells you if your ECT device is operating safely — providing reassurance and peace of mind. EctoBrain™ II works with any Thymatron® or MECTA device.

EctoBrain™ II also features a Patient Simulator mode that generates EEG, ECG, and EMG signals derived from real patients for testing up to 4 channels of your monitor/printer tracing display and for training and demonstration purposes. Both good- and poor-quality seizures can be selected.

The good-quality seizure shows a high amplitude EEG followed by electrical silence at termination, with a pronounced tachycardia response and a high-amplitude EMG that terminates shortly before EEG termination. The poor-quality recording exhibits a low-amplitude abortive-type EEG seizure lasting only 10 sec, followed by continued but lower-amplitude EEG fluctuations after termination; there is no tachycardia response, and an initial low-amplitude EMG response lasts only a few seconds.

A device checkup can cost $600 to $800 but real costs are more. How often does the question arise in treating a difficult patient whether the ECT device is stimulating properly or the EEG tracing recording correctly? Most ECT units sent to us for presumed malfunction have nothing wrong with them! EctoBrain™ II can quickly determine whether or not the device is working. It can reveal problems in technique (e.g., recording electrode application) that are correctable on site or with user-replaceable parts (e.g., leadwires). Just connect the stimulus and recording cables and press the TREAT button as for a patient.

The chart recorder of your ECT device will display samples of EEG, ECG, and EMG tracings as described above. The printed report will show the values of the stimulus parameters and other printed variables of your ECT device, including the measured stimulus charge output in mC.