The Streamlined Somatics Thymatron®
System Saves Time and Effort

Your Time is Valuable...Save It With:• Thymapad™ single use stimulus electrodes, for all placements• Ventil-A™ single use compressible mouth protectors• Recording electrodes, single use, for EEG, ECG and EMG• Thymatron® remote treat handle• Steady increment stimulus adjustment for dosing & titration
Single use = no cleanup, no sterilization, no contamination.
Made for use with Thymatron® System IV.

SOMATICS, LLC

720 Commerce Drive, Suite 101
Venice, Florida 34292

USA & Canada toll-free 1-800-642-6761(847) 234-6761
FAX (847) 234-6763
sales@thymatron.com

1540 OHM

55%

The Thymatron System IV:
Description and Specifications®

Cat. #EDIV

Choose ultrabrief (0.25 msec or 0.3 msec) or brief (0.5,
0.75, 1.0, 1.5 msec) at each dose setting. Each pulsewidth is available at every dose from minimum dose
to maximum.
One dial sets the dose. Pulsewidth and frequency are
individually assigned for each dose setting. Store yourpreferences for them in system memory or choosea factory-set group of pulsewidths and frequencies(called “stimulus programs.”)• EXTENDED LOWER STIMULUS RANGE withpulsewidth and frequency to 0.25 or 0.3 msec and 10
Hz allows you to deliver stimuli up to 8 seconds long.

About our Ventil-A single-use mouth protectors:“Contemporary disposable foam bite block provides
superior protection compared with the rubber bite
blocks of the past, as well as increased convenience.” –Paparone P, et al. JECT; 35:224.(2019)

correlates of seizure quality and efficacy ( Krystal &Weiner, 1994; Krystal et al, 1995; Krystal, 1998).

• EEG COHERENCE MEASURES of maximum sustained coherence, and time to peak coherence, interPrint your choice of any of these, or change among
hemispheric cross-correlation measures reported tothem as you wish: 1 or 2 channels of EEG alone or withreflect seizure quality and clinical impact (Krystal &ECG or EMG or both, or 4 channels of EEG.
Weiner, 1994; Krystal et al, 1995; Krystal, 1998).
The Thymatron’s 900 mA stimulus current induces sei• EEG AMPLITUDE measures of maximum sustained
zure at just 60% of the charge needed with 800 mA stimuEEG power, and average seizure energy, with separateli. Moreover, greater seizure induction occurs at 900 mA
values for early, mid– and postictal seizure phases,
than 800 mA, including at maximum device settings.
found by the Duke University group to be important• SINGLE FRONT-PANEL DIAL lets you selectthe 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.
• ELECTRONIC MEDICAL RECORD-KEEPING
is simple with the included GenieTM IV EMR
software. Patient treatment records created andstored with the GenieTM IV are easily incorporated into hospital database systems.

• HEART RATE MEASURES, including peak heartrate, a key measure of cerebral seizure duration andquality (Larson, Swartz & Abrams, 1984; Swartz,
1993; 1996; Swartz and Manly, 2000) that reflects theautonomic (brainstem) response to ECT. This is supplemented by digital heart rate monitoring for safety
and seizure generalization, printed each second.
All of the above measures are automatically printed.
• 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 GenieTM IV software.

• 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 pad after the treatment andpress a button for a complete printout.

THYMATRON ® SYSTEM IV FEATURES CHECKLIST 1
Thymatron®
System IV• INDEPENDENT SAFETY MONITOR CIRCUIT prevents thepatient from receiving an excessive electrical dose regardlessof the operation of the regular circuits.

Choose 0.25 or 0.3 msec Ultrabrief Pulsewidth• 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 etal, 1988).

Stimulus Programs• Because the special computer-automated programs of theThymatron® System IV are stored on REPLACEABLEMICROCHIPS, updates are easily accomplished on-site via
chip replacement. Somatics has already provided 4 advanced
microchip upgrades for the System IV including: GenieTM IV
computer software, and real-time digital EEG display.
• The POSTICTAL SUPPRESSION INDEX reports the degreeof EEG flattening immediately following the seizure, whichcorrelates with clinical efficacy (Nobler et al, 1993; Krystal& Weiner, 1994; Krystal et al, 1995; Krystal, 1998; Nobler etal, 2000). A study of the Thymatron®’s Postictal Suppression
Index found that it significantly differentiated ECT remittersfrom non-remitters (Petrides et al, 2000). The authors concluded: “higher PSI values (more abrupt ending of ictal EEG) arecorrelated 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).
• JUST SET ACCORDING TO AGE AND TREAT. Setting theThymatron® System IV according to the patient’s age facilitates easy selection of the correct 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 research based dose increments: 5, 10, 15,
25, 40, 80, and 100% Energy at your choice of pulsewidth.
(see next page for references)

Genie™ IV Software
Four-Channel Monitor/PrinterMaximum Sustained EEG Amplitude
Continuous Digital Heart Rate Monitor
Peak Heart Rate Printout
EEG Coherence Analysis
Seizure Energy Index
Postictal Suppression Index
Maximum Dose Available at all Pulsewidths
Interictal Frontal Delta Analysis
Computer EEG Seizure Duration
Computer Motor Seizure Duration
True EMG Monitor
EEG Ictal Line Seizure Indicator
Light-Emitting Elapsed Time Display
Up to 8 Seconds of Stimulation
Change Waveform without Altering Dose
Audible EEG™ monitor
Instant Impedance Test
Extended Seizure Alert
Patented Safety Monitor Circuit

SPECIFICATIONSSTIMULUS 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 msec pulse).
Pulsewidth: 0.25 or 0.3 msec (choose one) and 0.5 - 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 is typically 504 mC current with 99.8
joules energy across 220 ohms impedance. Output for double dose modes (whereavailable) is typically 1008 mC current with 199.6 joules energy across 220 ohms.
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. /220240 volt, 50/60 Hz switchable.
APPROVALS: CSA, CE, ISO 13485:2016, IEC 60601

REFERENCES
Abrams R (2002): Electroconvulsive Therapy (4th Ed.), New York, Oxford U. Press.
Alkire MT (1998): Quantitative EEG correlations with brain glucose metabolic
rate during anesthesia in volunteers. Anesthesiology 89:323-33
Beale MD et al (1994): Stimulus dose titration in ECT: A 2-year clinical experience. Convul. Ther. 10:171-176.
Billard V et al (1997): A comparison of spectral edge, delta power, and bispectral
index as EEG measure of alfentanil, propofol, and midazolam drug effect.
Clin Pharmacol Ther. 62:45-58
Chanpattana W (2001): Seizure threshold in electroconvulsive therapy: Effect ofInstrument titration schedule. German J Psychiatry 51-56[http://www.gjpsy.uni-goettingen.de]
Couture LJ et al (1988): Monitoring seizure duration during electroconvulsive
therapy. Convul. Ther. 4:206-14.
Devanand DP et al (1998): The relative efficiency of altering pulse frequency ortrain duration when determining seizure threshold. JECT 14:227-235.
Fink M, Kahn RL (1957): Relation of EEG delta activity to behavioral response inelectroshock: Quantitative serial studies. Arch. Neurol. Psychiat. 78:516-525.
Hans P et al (2001): Effect of nitrous oxide on the bispectral index and the 95%
spectral edge frequency during propofol-fentanyl anaesthesia. Eur J
Anaesthesiol 16:779-83
Isenberg KE et al (1996): Effect of stimulus parameters on seizure threshold andduration. Convul. Ther. 12:68.
Krystal AD, Weiner RD (1994): ECT seizure therapeutic adequacy. Convul. Ther.
10:153-164.
Krystal et al (1995): The ictal EEG as a marker of adequate stimulus intensity withunilateral ECT. J. Neuropsych. 7:295-303.
Krystal AD (1998): The clinical utility of ictal EEG seizure adequacy models.
Psych. Ann. 28:30-35.
McCall et al (1993): A reappraisal of the role of caffeine in ECT. Am. J. Psych.
150:1543-1545.
Nobler MS et al (1993): EEG manifestations during ECT: Effects of electrodeplacement and stimulus intensity. Biol. Psych. 34:321-330.
Nobler MS et al (2000): Quantitative EEG during seizures induced by electroconvulsive therapy: relations to treatment modality and clinical features. I.
Global analyses. JECT 16:211-28.
Petrides G, Fink M (1996): The “half-age” stimulation strategy for ECT dosing.
Convul. Ther. 12:138-146.
Petrides G, Kellner C et al (2000): Can Ictal EEG Indices predict response to ECT?
[presentation] Jan. 2000 NCDEU meeting.
Rasmussen KG et al (1994): Possible impact of stimulus duration on seizure
threshold in ECT. Convul. Ther. 10:177-180.
Roemer et al (1990-91): Relation between pretreatment electroencephalographic
coherence measures and subsequent response to electroconvulsive therapy:
a preliminary study. Neuropsychobiology 24:121-124.
Sackeim et al (1996): The effects of electroconvulsive therapy on quantitative electroencephalograms: Relationship to clinical outcome. Arch. Gen. Psych.
53:814-824.

Sackeim et al (2001): Ultra-brief pulse ECT and the affective and cognitive consequences of ECT [abstract], JECT 17:76.
Sakai T, Sing H, et al (1999): Hypnotic endpoints vs. the bispectral index, 95%
spectral edge frequency and median frequency during propofol infusion
with or without fentanyl. Eur J Anaesthesiol 16:47-52
Swartz CM (2006): Electroconvulsive Therapy Stimulus dose Expressed asVolume of Seizure Foci. JECT, 54:8 (2006)
Swartz CM (1993): Beyond seizure duration as a measure of treatment quality.
Convul. Ther. 9:1-7.
Swartz CM et al (1994): Computer automated versus visually determined electroencephalographic and electromygraphic seizure duration. Convul.
Ther. 10:165-170.
Swartz CM (1996): Disconnection of electronencephalographic, motoric, and cardiac evidence of ECT seizure. Convul. Ther. 12:25-30.
Swartz CM, Manly DT (2000): Efficiency of the Stimulus characteristics of ECT.
Am. J. Psych. 157:1504-06#EEDS

SOMATICS’ OWN SINGLE USE
STICK ON EEG/ECG/EMG ELECTRODES

Easy and quick to use, “the pregelled electrodes provided
in the Thymatron DG starter kit. . . reduce preparationtime” (Convulsive Therapy 2:53, 1986), compared to metalelectrodes and ordinary disposable paper ECG electrodes.
They are small enough not to interfere with treatment electrode placement. Ideal for recording EEG, ECG, and EMG,
they are conveniently packaged 5 per strip. Instantly adherent, they will remain in place throughout the seizure.

Updated “Guide to ECT” E-book Gratis
Get your copy of the “Guide to ECT” E-book revised
by Conrad Swartz PhD MD. It contains essential
written information, according to Dr. Swartz, andis suitable for physicians, residents and nurses. It
details organization, patient selection, pretreatment
procedures, electrical aspects, electrode placement,
anesthesia, monitoring, complications, side effects, andpost-ECT considerations.
It’s the first ECT guide to include the 2019 FDA ECTregulations (“special controls”). These describe newdetails of clinical practice the FDA expects ECTpractitioners in the USA to know and follow.
For a gratis PDF copy just email a request to
edu@thymatron.com with your name, degree, city andaffiliated hospital name.
#ENSI

NEW REMOTE TREATHANDLE FOR
THYMATRON®
You asked for a remote treat handle andhere it is. You can press the TREAT buttonon this handle instead of reaching over tothe Thymatron® itself: a simple thumbpress safely triggers the stimulus for any
electrode placement, including unilateral.

A ONE-PAGE COURSE IN ADVANCEDELECTROCONVULSIVE THERAPY% Energy set..........................................................................................................45%% Energy delivered..............................................................................................45%
Charge delivered............................................................................................308 mC
Current............................................................................................................... 0.90 A
Stimulus Duration...........................................................................................7.2 sec
Frequency...........................................................................................................70 Hz
Pulse Width................................................................................................... 0.3 msec
Static Impedance...................................................................................... 1440 ohms
Dynamic Impedance.................................................................................. 260 ohms
EEG Seizure Endpoint.....................................................................................48 sec
EMG Endpoint...................................................................................................45 sec

Peak Heart Rate...........................................................................................128/min
Average Seizure Energy Index....................................................................... 72 V2
Postictal Suppression Index.............................................................................96%
Maximum Sustained Power...................................................................77841 μV2Time to Peak Amplitude................................................................................33 sec
Maximum Sustained Coherence.....................................................................95%
Time to Peak Coherence................................................................................33 sec
Early Ictal Amplitude...................................................................................133 μV
Midictal amplitude.......................................................................................264 μV
Post-ictal amplitude........................................................................................10 μV

This sample ECT report of the Thymatron® System IV shows that the doctor set the % Energy dial to his patient’s ageof 45 years, yielding a 308 mC stimulus charge. The Optimal Stimulus Program selected a 0.3 msec pulsewidth, 70 Hz
frequency stimulus delivered over 7.2 sec. Prior to stimulus administration the impedance measured a safe 1440
ohms, which dropped to 260 ohms during stimulus delivery.
The EEG seizure lasted 48 seconds. Peak seizure amplitude was reached at 31 sec, with a mid-ictal amplitude of
264 μV, a Maximum Sustained Power of 77841 μV2, and an Average Seizure Energy Index of 72 V2 reflecting strong
seizure intensity.
Peak Interhemispheric Coherence reached at 33 sec was consistent with the seizure amplitude peak at 31 sec. The
Maximum Sustained Coherence value of 95% reflected synchronous participation of both hemispheres in the seizure.
The rapid drop of EEG seizure amplitude to 10 μV postictally yielded a high Postictal Suppression Index of 96%.
Power Spectral Analysis was not enabled.
In summary, the record shows a synchronous, high-intensity, well-developed, and well-generalized EEG seizure patternwith a strong midictal phase, pronounced postictal suppression, and a substantial tachycardia response.

GENIE™ IV ELECTRONIC PATIENT DATABASEAND EEG DISPLAY SYSTEM
Designed to meet your clinical and research needs, the Genie™ IV enables you to enter complete patient information at eachtreatment for storing, printing or incorporating into a hospital-based electronic patient database system.
Equally important is the Genie™ IV’s comprehensive real-time display of up to 4 channels of EEG, ECG, and EMG on a PC
screen (not included), allowing you to see and then store each treatment session.

(GENIE™ IV Patient Information Data File/Printout)
Date: 12-16-05 Name: Laurenz Smarba Age: 58
Sex: M
Somewhat improved but still has insomnia & poor appetite
Oriented, alert, coherent and cooperative
ECT #3 (R-UNI x 1)
Anesthesia: Dr. Jones
ECT: Dr. Smith
Atropine 0.2 mg - Brevital 50 mg - Succinylcholine 40 mg
Thymatron IV 85% Energy(LOW 0.5 program)Moderately strong seizure-symmetrical, well developed
Good heart rate response with rapid return to baseline
No complications, quick recovery
Recommendation for ECT #4: same as above

DOES YOUR ECT DEVICE DELIVER THE DOSE YOU SPECIFY?
DO YOU TRAIN DOCTORS OR NURSES IN ECT QUALITY?
Device malfunction can cause ineffective ECT treatments or excessive side-effects. Now you
can check your ECT device yourself with Somatics’ easy-to-use, ECTOBRAIN™II, which
performs the same current output check professional engineers use. A single button press
instantly tells you if your ECT device is operating safely— providing reassurance and peaceof mind. ECTOBRAIN™II works with any Thymatron.®
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/printertracing 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 afew seconds.
A device checkup can cost $600 to $800 but real costs are more. How often does the question arise in treating a difficult patientwhether 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 canreveal problems in technique (e.g., recording electrode application) that are correctable on site or with user-replaceable parts(e.g., lead wires). 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.
Special price when ordered together with a Thymatron® System IV.
The 2019 User’s Manual for the Thymatron®
System IV ECT device is now available forfree download at Thymatron.com. Click“Downloads” in the left column then click“Instruction Manual”. It includes these FDAmandated statements:• Specific “Instructions to Patients” (seemanual Addendum III).
• ECT patients should have cognitive statusassessed prior to ECT and along the coursewith formal neuropsychological assessment(see manual page 11).
• Cautions, warnings and risks, pp 1 and 7-11.
• Review of Thymatron® ECT device efficacy
publications, pp 13-15• Review of Thymatron® ECT device safety
publications, pp 15-19• Specific indications for use of ECT on
patients, p6*See specified sections of Ectobrain™ II manual on www.thymatron.com
downloads page

MOUTHGUARD ORAL PROTECTORS IN TWO SIZES

#EMGD

#EMGS

SOMATICS THYMATRON® INSTRUMENTS IMPORTANT
RESEARCH TOOLS
Since the Thymatron® was first introduced in 1983
hundreds of research studies have appeared in the
medical literature using a Thymatron® instrument.
Prominent among these is the series of publications by
the multi-hospital CORE research group, a consortiumof academic psychiatric centers.
In a series of important articles over the last decade
the CORE group used Thymatron® ECT instruments todemonstrate the striking efficacy of ECT in the treatment of psychotic depression (Petrides et al, 2001), to
determine that age had a strong positive association
with the response to bilateral ECT (O’Connor et al,2001), to show that DSM III melancholic features areunreliable predictors of ECT response (Fink et al,2007), to find that unipolar and bipolar depressives respond equally well to ECT (Bailine et al, 2010), and toreport that, although fewer black than white depressed
patients received ECT, there was no overall racial difference in treatment response (Williams et al, 2008).
Hundreds of other studies used a Thymatron® instrument to demonstrate, among other things, that:

ECT given twice a week was equally effective as threetimes a week, but with fewer cognitive side-effects(Lerer et al, 1995).
Antidepressant potency of high-dose right unilateral
ECT was equal to bilateral ECT (Abrams et al, 1991).
Caffeine lengthened seizure duration but did notchange the convulsive threshold (McCall et al, 1993).
Bilateral ECT did not yield any evidence for brain
damage as measured by levels of neuron-specific enolase and S-100 protein (Agelink et al, 2001).
None of 7 patients with intracranial masses were neurologically adversely affected by ECT (Rasmussen et al, 2007).
In 28 severely depressed patients given a course of
unilateral ECT, only responders showed elevations ofN-acetylaspartate, suggesting that ECT exhibits positive neurotrophic effects (Michael et al, 2003).
In 32 consecutive patients seizure durations automatically reported by the Thymatron instrument correlated
highly with determinations made by trained physicians (Rosenquist et al, 1998).

REFERENCES
Abrams R et al (1991) Arch Gen Psych 48:746; Agelink MW et al (2001) J Neurol Neurosurg Psych 71:394; Aten et al (2015) Eur Arch Psych Clin Neuro 265:351;
Bailine S et al (2010) Acta Psychiat Scand 121:431; Eranti S et al (2007)Am J Psych 164:73; Fink M et al (2007) JECT 23:139; Lerer B et al (1995) Am J Psych 152:564;
McCall WV et al (1993) Am J Psych 150:1543; Michael N et al (2003) Neuropsychopharm 28:270; O’Connor MK et al (2001) Am J Ger Psych 9:382; Petrides G et al(2001) JECT 17:244; Rasmussen KG (2007) J Neuropsych Clin Neurosci 19:191; Rosenquist PB et al (1998) JECT 14:76; Tew el al (1999) Am J Psych 156:1865; Williams
MD et al (2008) JECT 24:117

Thymatron Others
2015
2014
2013
2012
2011
2010

183
572
246
302
355
416

137
369
149
179
222
255

This yield of articles from a 6-year Google Scholar searchon the terms electroconvulsive+year+device demonstrates
that the Somatics Thymatron® is the ECT instrument most
preferred by ECT scholars and experts over all other ECT
devices.

SOMATICS, LLC

720 Commerce Drive, Suite 101
Venice, Florida 34292

www.thymatron.com

USA & Canada toll-free 1 (800) 642-6761(847) 234-6761
FAX (847) 234-6763
sales@thymatron.com“Thymatron® System IV: The most advanced
ECT device technically and operationally.”
SAFE, TIME-SAVING SINGLE USE ITEMS FOR ECTTHYMAPAD™ Stick-On Stimulus Electrodes
Thymapads™ are much faster and easier to use than theold-fashioned disk, headstrap, and jelly method.
#EPAD

They remain exactly where applied and have no exposed
metal surfaces to cause accidental shocks. There’s nomess to clean up afterwards, nothing to wash, dry, or sterilize, no sticky hands - just remove them and discard.
Thymapads™ flexibly conform to the surface of the head.

VENTIL-A™ Mouth Protector
The Ventil-A™’s thick 100% closed-cell foam construction protects all the teeth. Fits
easily under any anesthesia mask and features a non-collapsible air channel
for free flow oxygen. One-piece design for dimensional stability andlooped end for fast and easy insertion/removal. One size fits >98% of
adults.

#VENT

Both of these single-use ECT aids save the time and expense of washing and sterilizationand eliminate the risk of cross-infection that occurs with re-usable products.

ML-TS4, Rev 13