Perceptual Learning with Right Unilateral versus Bilateral Electroconvulsive Therapy

SummaryPerceptual learning was examined with respect to variations in ECT electrode placement (bilateral versus right unilateral) and ECT stimulus waveform (sinusoidal versus brief-pulse). While patients receiving right unilateral ECT demonstrated more perceptual learning than did those receiving bilateral ECT, no difference in perceptual learning resulted from the variation in electrical stimulus waveform. Furthermore, the amount of perceptual learning was unaffected by EEG seizure duration and by the total amount of electrical stimulus energy delivered. The theoretical issue of whether an electrical or a seizure difference between bilateral and right unilateral ECT is responsible for inter-group learning or memory differences is discussed, as well as practical issues related to the choice of electrode placement.

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Electroconvulsive Therapy: Electric Stimulus Variables and the Convulsive Response

The Canadian Journal of Psychiatry ◽

10.1177/070674379103600902 ◽

1991 ◽

Vol 36 (9) ◽

pp. 630-636 ◽

Cited By ~ 5

Author(s):

G.J. Bean ◽

A.E. Rhodes ◽

B.A. Martin

Keyword(s):

Electroconvulsive Therapy ◽

Electrical Energy ◽

Electrical Stimulus ◽

Routine Clinical Practice ◽

Electrode Placement ◽

Treatment Protocols ◽

Electric Stimulus ◽

Stimulus Waveform ◽

Stimulus Energy ◽

Grand Mal

The ability of an electrical stimulus to induce a grand mal convulsion during electroconvulsive therapy (ECT) was investigated using four clinical treatment protocols during which the stimulus waveform, the electrical energy and/or the electrode placement were varied. The statistically significant results support the view that a pulsatile square wave stimulus is effective in inducing convulsions, provided that the d'Elia and not the Muller unilateral electrode placement is used. Higher stimulus energy may be required for older patients. The results illustrate successive attempts to remedy a previously reported problem with the effectiveness of the pulsatile waveform as a convulsive stimulus. The benefit of maintaining a database of treatment variables in order to monitor the effect of changes in the protocol under conditions of routine clinical practice is also demonstrated.

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Alfentanil anesthetic augmentation lengthens seizure duration in electroconvulsive therapy with older people

International Psychogeriatrics ◽

10.1017/s1041610216000119 ◽

2016 ◽

Vol 28 (6) ◽

pp. 1051-1052

Author(s):

Craig D'Cunha ◽

Christos Plakiotis ◽

Daniel W. O'Connor

Keyword(s):

Side Effects ◽

Older People ◽

Electroconvulsive Therapy ◽

Electrode Placement ◽

Seizure Threshold ◽

Dose Titration ◽

Seizure Duration ◽

New Learning ◽

Prescription Rates ◽

Cognitive Side Effects

Electroconvulsive therapy (ECT) prescription rates rise with age, making it important that treatments be made as effective and safe as possible (Plakiotis et al., 2012). Older people are vulnerable to post-treatment confusion and to subsequent deficits in attention, new learning, and autobiographical memory (Gardner and O'Connor, 2008). Strategies to minimize cognitive side-effects include unilateral electrode placement and stimulus dose titration whereby electrical charge is individually calibrated to seizure threshold (Sackeim et al., 2000). It remains the case, however, that threshold levels typically rise over the treatment course, leading to an increase both in delivered charge and the risk of adverse sequelae.

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Electrode Placement, Stimulus Dosing and Seizure Monitoring during ECT

Australian & New Zealand Journal of Psychiatry ◽

10.1080/00048679409080791 ◽

1994 ◽

Vol 28 (4) ◽

pp. 675-683 ◽

Cited By ~ 5

Author(s):

G. Murugesan

Keyword(s):

Cognitive Impairment ◽

Electroconvulsive Therapy ◽

Electrical Stimulus ◽

Electrode Placement ◽

Treatment Modalities ◽

Points Of View ◽

Bilateral Treatment

Electroconvulsive therapy is one of the most useful, safe and predictable treatment modalities in psychiatry. For optimal results proper application of the procedure is essential. Over the years the procedure has undergone considerable refinement, yet not all those who administer the treatment are fully conversant with this. This paper addresses issues relating to electrode placement, stimulus dosing and seizure monitoring from practical and clinical points of view. Right unilateral ECT, if administered with high electrical stimulus, produces results close to bilateral treatment with substantially less cognitive impairment. However, certain patients may only respond to bilateral ECT. Adequate training for clinicians administering ECT is recommended.

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Electric Stimulus Energy and the Clinical Response to Electroconvulsive Therapy

The Canadian Journal of Psychiatry ◽

10.1177/070674379103600903 ◽

1991 ◽

Vol 36 (9) ◽

pp. 637-644 ◽

Cited By ~ 6

Author(s):

G.J. Bean ◽

V. Marchese ◽

B.A. Martin

Keyword(s):

Clinical Response ◽

Electroconvulsive Therapy ◽

Routine Clinical Practice ◽

Therapeutic Effectiveness ◽

Seizure Duration ◽

Electric Stimulus ◽

Stimulus Energy ◽

Significant Difference ◽

Clinical Conditions ◽

The Relationship

The relationship between electric stimulus energy and clinical response was examined in depressed patients receiving electroconvulsive therapy (ECT) under routine clinical conditions with a protocol which dichotomized the stimulus energy by patient age. There was no significant difference in the number of treatments and cumulative seizure duration between groups. The results support the observation that the stimulus energy may contribute to the therapeutic effect of ECT. Reduction of that energy in order to minimize side-effects may compromise the therapeutic effectiveness. The implications for dosage strategies in routine clinical practice are discussed.

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Computational comparison of conventional and novel electroconvulsive therapy electrode placements for the treatment of depression

European Psychiatry ◽

10.1016/j.eurpsy.2019.05.006 ◽

2019 ◽

Vol 60 ◽

pp. 71-78 ◽

Cited By ~ 2

Author(s):

Siwei Bai ◽

Donel Martin ◽

Tianruo Guo ◽

Socrates Dokos ◽

Colleen Loo

Keyword(s):

Electroconvulsive Therapy ◽

Regional Differences ◽

Computational Modelling ◽

Human Head ◽

Brain Regions ◽

Electrical Stimulus ◽

Electrode Placement ◽

Treatment Of Depression ◽

Mri Scans ◽

Average Electric Field

AbstractBackground:Electroconvulsive therapy (ECT) is a highly effective treatment for severe psychiatric disorders. Despite its high efficacy, the use of ECT would be greater if the risk of cognitive side effects were reduced. Over the last 20 years, developments in ECT technique, including improvements in the dosing methodology and modification of the stimulus waveform, have allowed for improved treatment methods with reduced adverse cognitive effects. There is increasing evidence that the electrode placement is important for orienting the electrical stimulus and therefore modifying treatment outcomes, with potential for further improvement of the placements currently used in ECT.Objective:We used computational modelling to perform an in-depth examination into regional differences in brain excitation by the ECT stimulus for several lesser known and novel electrode placements, in order to investigate the potential for an electrode placement that may optimise clinical outcomes.Methods:High resolution finite element human head models were generated from MRI scans of three subjects. The models were used to compare regional differences in average electric field (EF) magnitude among a total of thirteen bipolar ECT electrode placements, i.e. three conventional placements as well as ten lesser known and novel placements.Results and conclusion:In this exploratory study on a systemic comparison of thirteen ECT electrode placements, the EF magnitude at regions of interest (ROIs) was highly dependent upon the position of both electrodes, especially the ROIs close to the cortical surface. Compared to conventional right-unilateral (RUL) ECT using a temporo-parietal placement, fronto-parietal and supraorbito-parietal RUL also robustly stimulated brain regions considered important for efficacy, while sparing regions related to cognitive functions, and may be a preferrable approach to the currently used placement for RUL ECT. The simulations also found that regional average EF magnitude varied between individual subjects, due to factors such as head size, and results also depended on the size of the defined ROI.

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Electroconvulsive Therapy and the Stimulus Waveform*

The Canadian Journal of Psychiatry ◽

10.1177/070674378302800606 ◽

1983 ◽

Vol 28 (6) ◽

pp. 438-440 ◽

Cited By ~ 6

Author(s):

G.E. Harris-Brandts ◽

B.A. Martin

Keyword(s):

Electroconvulsive Therapy ◽

Electrical Energy ◽

Electrical Stimulus ◽

Effective Dosage ◽

Therapeutic Principle ◽

The Past ◽

Stimulus Waveform ◽

Sinusoidal Waveform ◽

Minimum Effective Dosage

The amount of electrical energy transmitted to the patient while inducing a seizure during electroconvulsive therapy (ECT) may vary considerably depending on the waveform of the electrical stimulus. The majority of ECT equipment used in the past employed a sinusoidal waveform for the stimulus. Advances in waveform technology have led to the development of pulsatile waveforms which are effective convulsants requiring a fraction of the electrical energy transmitted by the sinusoidal waveform. This paper summarizes the clinically relevant advances in waveform technology. The therapeutic principle of using the minimum effective dosage is emphasized.

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