A comparative study of the cognitive side effects of bitemporal and bifrontal electroconvulsive therapy

Elhadad, Ayman A; Elhamrawy, Lamiaa; Shalaby, Amro; Jomaa, Eman; Kasem, Mostafa

doi:10.1097/01.xme.0000516721.16137.4a

Cited by 1 publication

(1 citation statement)

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“…In Kellner’s et al (2010) study, most measures showed no difference between the three, although RUL did show a benefit over both BF and BT for reorientation at 20 minutes (which correlates with retrograde memory loss) and BF showed an advantage over BT on one anterograde memory measure. In contrast to Kellner, a randomised controlled trial (RCT) reported by Elhadad et al (2017) found BF ECT to have a cognitive advantage over BT ECT (as measured by the MoCA), although this study included patients with mania and schizophrenia as well as depression. In Dunne and McLoughlin’s, 2012 meta-analysis, BF and RUL were equivalent in cognitive side effects, but BT was significantly worse than BF on global cognitive impairment, as measured by the MMSE, although this does not measure many of the cognitive domains affected by ECT.…”

Section: Bifrontal Bp Ect – Cognitive Side Effectsmentioning

confidence: 85%

Prescribing electroconvulsive therapy for depression: Not as simple as it used to be

Gill

Hussain

Purushothaman

et al. 2023

Aust N Z J Psychiatry

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In the last century, prescribing electroconvulsive therapy usually involved considering the relative merits of unilateral versus bilateral electroconvulsive therapy, with most other parameters fixed. However, research over the last 30 years has discovered that several parameters of the electroconvulsive therapy stimulus can have a significant impact on efficacy and cognitive side effects. The stimulus dose relative to seizure threshold was shown to significantly affect efficacy, especially for right unilateral electroconvulsive therapy, where suprathreshold doses in the vicinity of 5–6 times seizure threshold were far more efficacious than doses closer to threshold. However, this did not hold for bitemporal electroconvulsive therapy, where near-threshold stimuli were equally effective as suprathreshold stimuli. Then, changes in stimulus pulse width were found to also have a significant impact on both efficacy and side effects, with ultrabrief pulse widths of 0.3 ms having significantly fewer cognitive side effects in unilateral electroconvulsive therapy than standard brief pulse widths of 1.0 ms, with only slightly reduced efficacy. Therefore, choosing the optimum electroconvulsive therapy prescription for an individual patient now requires consideration of placement, pulse width and stimulus dose relative to seizure threshold, and how these three interact with each other. This viewpoint aims to raise awareness of these issues for psychiatrists involved in electroconvulsive therapy practice.

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Section: Bifrontal Bp Ect – Cognitive Side Effectsmentioning

confidence: 85%