Letter to the Editor: Electrode placement in electroconvulsive therapy – bilateral is still the ‘gold standard’ for some patients

Kellner, Charles H.; Çiçek, Mustafa Cüneyt; Ables, Jessica L.

doi:10.1017/s0033291716003536

Cited by 9 publications

(5 citation statements)

References 7 publications

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“…The role and selection of bilateral and unilateral ECT has become a subject of debate . Our report suggesting a simple new method for eliciting adequate seizures during ECT in high seizure threshold cases may add a new viewpoint to this controversy.…”

Section: Discussionmentioning

confidence: 86%

When to switch from bilateral to unilateral electroconvulsive therapy: A simple way to elicit seizures in high seizure threshold cases

Eda

Matsuki

2018

Neuropsychopharm Rep

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Aims Although electroconvulsive therapy (ECT) is effective for various psychiatric disorders, its therapeutic effect depends on the occurrence of adequate seizures. Thus, the management of inadequate seizures remains a clinical problem. Here, we aimed to develop a simple method to elicit adequate seizures in high seizure threshold patients during ECT sessions. Methods Right unilateral ECT was performed in 87 sessions (22 inpatients) in which 504 millicoulombs bilateral (bitemporal or bifrontal) electrical stimulation had failed to induce adequate seizures. A Thymatron® System IV (Somatics LLC, Lake Bluff, IL, USA) and the LOW 0.5 program were used in accordance with the manufacturer's instructions. The electrode placement was bitemporal, bifrontal, or right unilateral (d'Elia placement). The minimum duration for an adequate seizure was 15 seconds in the electroencephalogram record of the Thymatron® stimulator. The efficacy of treatment was estimated by the Global Assessment of Functioning at the time of admission and discharge. Cognitive assessment was not performed. Results By switching to right unilateral stimulation immediately after failure of bilateral stimulation, adequate seizures were achieved in 71 of 87 (81.6%) sessions. Improvement in the Global Assessment of Functioning was observed in 23 of 28 (82.1%) treatment courses. Conclusion Switching from bilateral to unilateral electrode placement may be a simple clinical option for eliciting adequate seizures in high seizure threshold cases.

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Section: Discussionmentioning

confidence: 86%

When to switch from bilateral to unilateral electroconvulsive therapy: A simple way to elicit seizures in high seizure threshold cases

Eda

Matsuki

2018

Neuropsychopharm Rep

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“…We thank Dr Kellner and colleagues for their comments (Kellner et al 2016) on our recent systematic review and meta-analysis of randomized controlled trials of bitemporal v. high-dose right unilateral (RUL) electroconvulsive therapy (ECT) (Kolshus et al 2017). We found no significant differences in scores on the Hamilton Depression Rating Scale (seven trials) or in remission rates (six trials) between the two forms of ECT, with some cognitive advantages for high-dose RUL ECT.…”

mentioning

confidence: 86%

“…We thank Dr Kellner and colleagues for their comments (Kellner et al . 2016) on our recent systematic review and meta-analysis of randomized controlled trials of bitemporal v. high-dose right unilateral (RUL) electroconvulsive therapy (ECT) (Kolshus et al . 2017).…”

mentioning

confidence: 99%

Letter to the Editor: Electrode placement in electroconvulsive therapy – bilateral is still the ‘gold standard’ for some patients: a reply

2017

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“…Modern ECT can be broadly divided into three types depending on placement of electrodes and the pulse width of electricity administered. Although overall efficacy increases from UB-RUL to RUL to bilateral, 17,18 so do cognitive side-effects. In particular, reduction in scores on the CUAMI immediately following ECT follow the same gradient and are greater than for controls measured over the same time period.…”

Section: What Domains Of Cognitive Function Are Affected?mentioning

confidence: 99%

Cognitive side-effects of electroconvulsive therapy: what are they, how to monitor them and what to tell patients

et al. 2020

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Background Electroconvulsive therapy (ECT) is recommended in treatment guidelines as an efficacious therapy for treatment-resistant depression. However, it has been associated with loss of autobiographical memory and short-term reduction in new learning. Aims To provide clinically useful guidelines to aid clinicians in informing patients regarding the cognitive side-effects of ECT and in monitoring these during a course of ECT, using complex data. Method A Committee of clinical and academic experts from Australia and New Zealand met to the discuss the key issues pertaining to ECT and cognitive side-effects. Evidence regarding cognitive side-effects was reviewed, as was the limited evidence regarding how to monitor them. Both issues were supplemented by the clinical experience of the authors. Results Meta-analyses suggest that new learning is impaired immediately following ECT but that group mean scores return at least to baseline by 14 days after ECT. Other cognitive functions are generally unaffected. However, the finding of a mean score that is not reduced from baseline cannot be taken to indicate that impairment, particularly of new learning, cannot occur in individuals, particularly those who are at greater risk. Therefore, monitoring is still important. Evidence suggests that ECT does cause deficits in autobiographical memory. The evidence for schedules of testing to monitor cognitive side-effects is currently limited. We therefore make practical recommendations based on clinical experience. Conclusions Despite modern ECT techniques, cognitive side-effects remain an important issue, although their nature and degree remains to be clarified fully. In these circumstances it is useful for clinicians to have guidance regarding what to tell patients and how to monitor these side-effects clinically.

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Letter to the Editor: Electrode placement in electroconvulsive therapy – bilateral is still the ‘gold standard’ for some patients

Cited by 9 publications

References 7 publications

When to switch from bilateral to unilateral electroconvulsive therapy: A simple way to elicit seizures in high seizure threshold cases

When to switch from bilateral to unilateral electroconvulsive therapy: A simple way to elicit seizures in high seizure threshold cases

Letter to the Editor: Electrode placement in electroconvulsive therapy – bilateral is still the ‘gold standard’ for some patients: a reply

Cognitive side-effects of electroconvulsive therapy: what are they, how to monitor them and what to tell patients

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