The Thymatron® System IV:
Description and Specifications
• New ANESTHESIA DEPTH MONITOR provides continuous
feedback of anaesthesia level. Increasing use of Propofol
anaesthesia for ECT worldwide (Abrams, 2002) has made
Anaesthesia Depth Monitoring routine in many centres, due to
Propofol’s biphasic action and dose-related tendency to
shorten seizures. The Thymatron® System IV now includes
at no increase in price a front-panel Anaesthesia Depth
Monitor display of your choice of 3 EEG measures shown to
correlate significantly with anaesthesia depth level: 95%
Spectral Edge Frequency, Relative Delta power, and Median
Frequency (Billard et al, 1997; Alkire, 1998; Hirota et al, 1999;
McDonald et al, 1999; Sakai et al, 1999; Singh et al, 1999;
Hans et al, 2001; Kuizenga et al, 2001; Koitabashi et al, 2002).
• ULTRA-BRIEF 0.25 MS PULSEWIDTH STIMULUS program
for unilateral ECT allows you to administer this important
advance in therapy across the entire dosage range, with
durations up to 8 seconds for maximum effectiveness. The
high efficiency of ultra-brief pulse 6x threshold unilateral
ECT yields a substantial reduction in cognitive side-effects
while maintaining efficacy (Sackeim et al, 2001).
• STATE-OF-THE-ART 4-CHANNEL PRINTER allows you
to monitor two channels of EEG, plus ECG and EMG (or,
choose 4 channels of EEG), while providing hard-copy
documentation for later reference.
• SINGLE FRONT-PANEL DIAL lets you select the traditional
Thymatron® functions plus important new ones, including
Optimal Stimulus programs that automatically set the most
efficient combination of stimulus parameters at every stimulus
dose setting.
• EXTENDED LOWER STIMULUS RANGE with pulse width
and frequency settings to 1/4 msec and 20 Hz allows you to
deliver stimuli up to 8 seconds long, to optimize treatment in
accordance with research showing greater efficacy of short pulse width,
extended-duration stimuli (Isenberg et al, 1996).
• EEG COHERENCE MEASURES of maximum sustained
coherence, and time to peak coherence, inter-hemispheric
cross-correlation measures reported to reflect seizure quality
and clinical impact (Krystal & Weiner, 1994; Krystal et al,
1995; Krystal, 1998).
• EEG AMPLITUDE measures of maximum sustained EEG
power, and average seizure energy, with separate values for
early, mid– and post-ictal seizure phases, found by the Duke
University group to be important correlates of seizure quality
and efficacy ( Krystal & Weiner, 1994; Krystal et al, 1995;
Krystal, 1998).
• HEART RATE MEASURES, including peak heart rate,
a key measure of cerebral seizure duration and quality
(Larson, Swartz & Abrams, 1984; Swartz, 1993; 1996; Swartz
and Manly, 2000) that reflects the autonomic (brainstem)
response to ECT. This is supplemented by continuous
digital heart rate monitoring for safety and seizure generalization,
with the result printed each second.
• A POWERFUL 32-BIT INTERNAL COMPUTER employs
Power Spectral Analysis to process and store up to 10
minutes of digitized EEG for the special features described
here. You can send this data to your IBM PC-compatible
computer via a rear-panel serial port for further
COMPREHENSIVE EEG ANALYSIS, using Somatics'
proprietary software (or, store it on your Palm™ Computer).
• 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.
•PATENTED INDEPENDENT SAFETY MONITOR
CIRCUIT prevents the patient from receiving an excessive
electrical dose regardless of the operation of the regular
circuits.
• TRUE EMG RECORDING OF THE MOTOR SEIZURE.
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 optically-detectable movements
(Couture et al, 1988).
• Because the special computer-automated programs of the
Thymatron® System IV are stored on REPLACEABLE
MICROCHIPS, updates are easily accomplished on-site via
chip replacement. Somatics has already provided 4 advanced
microchip upgrades for the System IV: the ultra-brief 0.25 ms
pulse width program, Palm™ computer software, real-time
digital EEG monitoring, and the Anaesthesia Depth Monitor.
In comparison, any upgrades to the Mecta spectrum (there
have been none) would have required return to the factory.
• The PATENTED POSTICTAL SUPPRESSION INDEX
reports the degree of EEG flattening immediately following
the seizure, which correlates with clinical efficacy (Nobler et
al, 1993; Krystal & Weiner, 1994; Krystal et al, 1995; Krystal,
1998; Nobler et al, 2000). A recent study of the Thymatron®’s
Post-ictal Suppression Index found that it significantly differentiated
ECT remitters from non-remitters (Petrides et al,
2000). The authors concluded: “higher PSI values (more
abrupt ending of ictal EEG) are correlated with better clinical
outcome of ECT in depression”.
• COMPUTER DETERMINATION AND PRINTOUT OF
EEG AND MOTOR SEIZURE DURATIONS. The integral
computer EEG analyzer continually measures the EEG and
EMG and automatically prints the EEG and motor seizure
durations with precision and reliability (Swartz et al, 1994;
Krystal et al, 1995).
• THE PATENTED AUDIBLE EEG™ also provides continuous
EEG monitoring even if the recording paper runs out. It
correlates highly with the visual EEG (Swartz & Abrams,
1986) and keeps you constantly aware of the progress of
the EEG seizure without having to watch the recording.
• EXTENDED SEIZURE ALERT. Because longer seizures generate
more cognitive side-effects, many 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 selected interval has elapsed after
the seizure, and monitoring has not been terminated.
• JUST SET ACCORDING TO AGE AND TREAT. Setting
the Thymatron® System IV according to the patient's age
facilitates easy selection of the stimulus charge.
• Alternatively, RAPID STIMULUS TITRATION is facilitated
with the Thymatron® System IV using a simple method-of-limits
procedure (McCall et al, 1993; Rasmussen et al, 1994)
that employs uniform dose increments.
SPECIFICATIONS
STIMULUS OUTPUT: Current: 0.9 amp constant, limited to 450 volts, isolated
from line current.
Frequency: 10 to 70 Hz in 10 Hz increments (to 140 Hz for 0.25 ms pulse).
Pulse width: 0.25 to 1.5 msec in 0.25 msec increments.
Duration: 0.14 to 8.0 sec in increments of equal charge.
Maximum output: Standard maximum output across 220 ohms impedance: 504
millicoulombs, 99.4 joules. Output with double-dose option (where available) across
220 ohms impedance: 1008 mC, 188.8 joules
RECORDING: 8 user-selectable gain positions: 10, 20, 50, 100, 200, 500, and 2000
μV/cm.
REQUIREMENTS: 100-130 volts (120 volts) A.C., 60 Hz, single phase. 100 VA. /220-240
volt, 50/60 Hz switchable.
APPROVALS: CSA, CE, ISO9000, TUV, IEC601