ECTOBRAIN™ II INSTRUCTION MANUAL(For Use with the Thymatron™ System IV)

Richard Abrams, M.D.
andJohn Pavel

First edition June 2002, ©Somatics LLC, all rights reserved

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SOMATICS, LLC
Lake Bluff, IL 60044

EctoBrain™ II provides the 6 different functions described below: ECT stimulus
output test; impedance test circuit check; ECT stimulus cable integrity check;recording channel and special features check; seizure quality recognition andidentification training; calibration of EEG amplifiers; and calibration of ECT
stimulus output.
EctoBrain™ II functions as a simulated patient and requires neither application ofelectrodes to a patient, nor administration of an impedance test or stimulus current
to a patient: it completely replaces the patient for testing and demonstration purposes.
I. ECT stimulus output test
This function measures the peak current of each stimulus pulse through a 200 ohm
dummy load (resistor) to determine whether the Thymatron™ is delivering theselected dosage.
1. Turn EctoBrain™ II “POWER” switch to “ON”; the green “POWER”
switch indicator will light (if it does not light, replace the 9V battery locatedin the rear compartment of the EctoBrain™ II).
2. Insert the 2 ECT stimulus cable banana plugs into the 200 ohm load jacks
located towards the top of the EctoBrain™ II front panel.
3. Connect the other end of the ECT stimulus cable to the Thymatron™ front
panel jack marked “ECT”.
4. Make sure the Thymatron™ contains recording paper.
5. Set the Thymatron™ “PERCENT ENERGY” dial to 100% and press andhold down the “TREAT” switch while observing the “OUTPUT TEST”
LEDs on the EctoBrain™ II front panel. If the green “OUTPUT TEST”
LED lights during stimulus activation, stimulus output is accurate to within+/- 5%, which is acceptable; the Thymatron™ may be used to treat patients.
6. (The chart recorder will automatically start to run when the “TREAT”
button is released—just press the “START/STOP” button on theThymatron™ front panel to generate a printed report of the actual stimulus
dose delivered.)
7. If the red “OUTPUT TEST” LED lights during stimulus activation, stimulus
output is too high or too low; further checks by a licensed biomedical
technician are required before the Thymatron™ is used to treat patients.
8. If neither the red nor the green “OUTPUT TEST” LED lights during
stimulus activation, the Thymatron™ is not delivering any stimulus at all.
Among other possibilities, this could result from a damaged ECT stimulus
cable, which can be tested as described in section III below. If such testingreveals the integrity of the ECT stimulus cable to the be compromised, thecable must be repaired or replaced. If the ECT stimulus cable is intact,
further checks of the Thymatron™ by a licensed biomedical technician are
required to determine the nature of the malfunction.

II. Impedance test circuit check
This function checks the accuracy of the impedance test circuitry by measuring theimpedance test current through the 200 ohm dummy load of the EctoBrain™ II.
1. Turn EctoBrain™ II “POWER” switch to “ON”; the green “POWER”
switch indicator will light (if it fails to light, replace the 9V battery located inthe rear compartment of the EctoBrain™ II).
2. Insert the 2 ECT stimulus cable banana plugs into the 200 ohm load jacks
located towards the top of the EctoBrain™ II front panel.
3. Connect the other end of the ECT stimulus cable to the Thymatron™ front
panel jack marked “ECT”.
4. Press the yellow “IMPEDANCE TEST” button on the Thymatron™ front
panel.
5. If the impedance test circuitry is functioning correctly (and if the ECTstimulus cable is intact), an impedance value in the range of 180 to 220 ohm
will appear in the light-emitting display.
6. If an impedance test value outside the 180 to 220 ohm range is displayed, theimpedance test circuitry and/or the ECT stimulus cable require further
checks by a licensed biomedical technician before the Thymatron™ is used totreat patients.

III. ECT stimulus cable integrity check1. Turn EctoBrain™ II “POWER” switch to “ON”; the green “POWER”
switch indicator will light (if it fails to light, replace the 9V battery located inthe rear compartment of the EctoBrain™ II).
2. Insert the 2 ECT stimulus cable banana plugs into the 200 ohm load jacks
located towards the top of the EctoBrain™ II front panel.
3. Connect the other end of the ECT stimulus cable to the Thymatron™ front
panel jack marked “ECT”.
4. Press the yellow “IMPEDANCE TEST” button on the Thymatron™ front
panel.
5. If an impedance test value between 40 and 220 ohm is displayed, then thestimulus cable is intact but the impedance test circuitry requires furtherchecks by a licensed biomedical technician before the Thymatron™ is used totreat patients.
6. If an impedance test value from 0 to 40 ohm is displayed, there may be ashort circuit in the cable or its connections, both of which must be checked
by a licensed biomedical technician before the Thymatron™ is used to treatpatients.
7. If the impedance test value appears as a flashing “>3000”, then the stimulus
cable may be broken and in need of repair or replacement.

IV. Recording channel and special features check
This function checks the integrity and accuracy of the recording channels and as
many of the special features as you wish to test (e.g., Automatic Seizure Endpoint
Detection, Seizure Quality Measures, Peak Heart Rate Printout, etc.)
1. Turn EctoBrain™ II “POWER” switch to “ON”; the green “POWER”
switch indicator will light (if it fails to light, replace the 9V battery located in
the rear compartment of the EctoBrain™ II).
2. Make sure the Thymatron™ contains recording paper.
3. Connect the black plastic end of the EctoBrain™ II cable to the front panel
EEG/ECG/EMG input jack of the Thymatron™.
4. Insert the 2 ECT stimulus cable banana plugs into the 200 ohm load jacks
located towards the top of the EctoBrain™ II front panel.
5. Connect the other end of the ECT stimulus cable to the Thymatron™ front
panel jack marked “ECT”.
6. Flip the EctoBrain™ II “MODE” switch up to “AUTO”; flip theEctoBrain™ II “SEIZURE” switch up towards “GOOD”.
7. Use the Thymatron™ front panel FlexDial™ to enable as many of the 4recording channels as desired, and to select and set the ECT stimulus
parameters and as many of the special features as you wish to test.
8. Set the Thymatron™ “PERCENT ENERGY” dial to deliver the desireddose.
9. Press the yellow “IMPEDANCE TEST” button on the Thymatron™ front
panel to see the impedance displayed in the light-emitting display, and thenrelease; then wait several seconds after the impedance test value disappears
from the light-emitting display for the “READY” message to appear in its
place.
10. Press and hold down the Thymatron™ “TREAT” switch until stimulus
delivery is complete.
11. Observe the entire seizure sequence of about 40 sec duration on the paper
strip printout, and press the “START/STOP” button of the printer at least 6
seconds after the EEG seizure ends (e.g., at about 46 sec) to terminate
recording and generate the end-of-treatment printed report.
12. The appearance in the end-of-treatment printed report of each of thechannels and special features selected demonstrates that each is functioning
correctly.

V. Training in seizure quality recognition and identification
AUTOMATIC MODE

Displays the full seizure sequence with a single button press. Select automatic modeby flipping the “MODE” switch up to “AUTO”.
In automatic mode you also have the choice to display either a good- or a poorquality seizure pattern.
The good quality seizure is represented by a high amplitude EEG of substantial
duration, followed by electrical silence at termination. There is a pronounced tachycardia
during the seizure, and a well-developed EMG response that terminates before the EEG
does. Select a good quality seizure by flipping the “SEIZURE” switch (far right-hand side of
EctoBrain™ II front panel) up in the direction of the word “GOOD”.
The poor-quality seizure is represented by a low-amplitude EEG pattern lasting lessthan 20 sec, and followed by mixed EEG fluctuations after termination in the alpha/betarange. There is no tachycardia response, and an initial poorly-formed EMG response lasts
only a few seconds. Select a poor quality seizure by flipping the “SEIZURE” switch down inthe direction of the word “POOR”

1. Turn EctoBrain™ II “POWER” switch to “ON”; the green “POWER”
switch indicator will light (if it fails to light, replace the 9V battery located in
the rear compartment of the EctoBrain™ II).
2. Connect the black plastic end of the EctoBrain™ II cable to the front panel
EEG/ECG/EMG input jack of the Thymatron™.
3. Insert the 2 ECT stimulus cable banana plugs into the 200 ohm load jacks
located towards the top of the EctoBrain™ II front panel.
4. Connect the other end of the ECT stimulus cable to the Thymatron™ front
panel jack marked “ECT”.
5. Make sure the Thymatron™ contains recording paper.
6. Select AUTOMATIC mode by flipping the EctoBrain™ II “MODE” switch
up to “AUTO”.
7. Select good- or poor-quality seizure pattern by flipping EctoBrain™ II“SEIZURE” switch up towards “GOOD” or down towards “POOR”.
8. Set ECT stimulus parameters and dosage on the Thymatron™ as desired.
9. Press the yellow “IMPEDANCE TEST” button on the Thymatron™ front
panel to see the impedance displayed in the light-emitting display, and thenrelease; then wait several seconds after the impedance test value disappears
from the light-emitting display for the “READY” message to appear in itsplace.
10. Press the “TREAT” button; the paper chart drive will automatically begin torun when “TREAT” button is released.
11. Observe seizure on paper stripchart; after seizure termination (about 40 secfor a good seizure, and 19 sec for a poor one) wait at least 7 seconds and thenpress the “START/STOP” button on the Thymatron™ front panel toterminate recording and generate the end-of-treatment printed report.

MANUAL MODE
Allows the operator to demonstrate each of 3 seizure phases (baseline, seizure, andendpoint) for a good-quality seizure only. Select manual mode by flipping the“MODE” switch down to “MANUAL”. Select seizure phases to demonstrate bysetting the EctoBrain™ II “SEIZURE” switch up for baseline, in the middle position
for seizure, and down for endpoint:•••

Baseline simulates pre-treatment conditions and allows the system toobtain an EEG baseline.
Seizure simulates a good-quality seizure
Endpoint simulates the seizure ending and postictal condition

1. Turn EctoBrain™ II “POWER” switch to “ON”; the green “POWER”
switch indicator will light (if it fails to light, replace the 9V battery located inthe rear compartment of the EctoBrain™ II).
2. Connect the black plastic end of the EctoBrain™ II cable to the front panel
EEG/ECG/EMG input jack of the Thymatron™.
3. Insert the 2 ECT stimulus cable banana plugs into the 200 ohm load jacks
located towards the top of the EctoBrain™ II front panel.
4. Connect the other end of the ECT stimulus cable to the Thymatron™ front
panel jack marked “ECT”.
5. Make sure the Thymatron™ contains recording paper.
6. Select MANUAL mode by flipping the “MODE” switch down to“MANUAL”.
7. Set ECT stimulus parameters and dosage as desired.
8. Set EctoBrain™ II “SEIZURE” switch up for baseline recording pattern, tothe middle position for seizure recording pattern, or down for the endpoint
and postictal pattern.
9. Press “START/STOP” button on the Thymatron™ front panel to see
selected recording pattern on paper stripchart.
In EctoBrain™ II baseline mode, it’s simplest to press the “IMPEDANCE TEST”
button before starting the printer in order to demonstrate baseline EEG datacollection. Baseline collection has been accomplished when the “READY” messageappears in the light-emitting display, after which you can press the “START/STOP”
button of the Thymatron™ to display a printout of the baseline EEG.
(If you press the “START/STOP” button to run the stripchart and then press the“IMPEDANCE TEST” button you will still initiate baseline EEG sample collection,
but the printer will stop—just press “START/STOP” again for it to resumeprinting.)

VI. Calibration of EEG amplifiers and ECT stimulus output (CAUTION: To beaccomplished by a licensed biomedical technician only)This dual function allows a licensed biomedical technician to calibrate the EEG
amplifiers and the ECT stimulus output without the need for an oscilloscope. In“CAL” mode, the EctoBrain™ II continuously generates a 10 Hz, 200 microvolt
peak-to-peak test signal.
To calibrate EEG amplifiers:
1. Turn EctoBrain™ II “POWER” switch to “ON”; the green “POWER”
switch indicator will light (if it fails to light, replace the 9V battery
located in the rear compartment of the EctoBrain™ II).
2. Connect the black plastic end of the EctoBrain™ II cable to the front
panel EEG/ECG/EMG input jack of the Thymatron™.
3. Insert the 2 ECT stimulus cable banana plugs into the 200 ohm load jacks
located towards the top of the EctoBrain™ II front panel.
4. Connect the other end of the ECT stimulus cable to the Thymatron™
front panel jack marked “ECT”.
5. Select “CAL” mode mode by placing the EctoBrain™ II “MODE”
switch in the middle (“CAL”) position.
6. Follow the instructions in the Thymatron™ System IV Service Manualfor calibrating the EEG amplifiers. The calibration signal from theEctoBrain™ II will appear on the Thymatron™ stripchart printed
during the calibration procedure.

To calibrate ECT stimulus output:
1. Turn EctoBrain™ II “POWER” switch to “ON”; the green “POWER”
switch indicator will light (if it fails to light, replace the 9V battery
located in the rear compartment of the EctoBrain™ II).
2. Connect the black plastic end of the EctoBrain™ II cable to the front
panel EEG/ECG/EMG input jack of the Thymatron™.
3. Insert the 2 ECT stimulus cable banana plugs into the 200 ohm load jacks
located towards the top of the EctoBrain™ II front panel.
4. Connect the other end of the ECT stimulus cable to the Thymatron™
front panel jack marked “ECT”.
5. Select “CAL” mode mode by placing the EctoBrain™ II “MODE”
switch in the middle (“CAL”) position.
6. Follow the instructions in the Thymatron™ System IV Service Manualfor calibrating the ECT stimulus output. Identify which trimmer toadjust on the power board and adjust until both the red and green(“FAIL” and “PASS”) “OUTPUT TEST” LEDs of the EctoBrain™ II
are lit simultaneously.

Problem-solving using EctoBrain™ II(assumes Thymatron™ is plugged in and powered on, and contains
recording paper)
Problem

How to test using EctoBrain™ IINo stimulus output

Section I

Impedance testerror

Section II

ECT stimulus
cable failure

Section III

No EEG (EMG,ECG) endpoint

Section IV (with EEG endpoint detection enabled)

ECG channel
doesn’t print

Section IV (with ECG enabled in channel 4)

No Ictal Line

Section IV

Special feature
doesn’t print

Section IV (with special feature enabled)

EEG amplifiers
require calibration

Section VI (licensed biomedical technician only)

ECT stimulus
requirescalibration

Section VI (licensed biomedical technician only)