Cm. Swartz, ASYMMETRIC BILATERAL RIGHT FRONTOTEMPORAL LEFT FRONTAL STIMULUS ELECTRODE PLACEMENT FOR ELECTROCONVULSIVE-THERAPY, Neuropsychobiology, 29(4), 1994, pp. 174-178
The development is described of a new stimulus electrode placement for
electroconvulsive therapy (ECT) from expectations that relate the loc
ation and volume of induced seizure foci to side effects and efficacy,
respectively. These expectations are that cognitive side effects woul
d be minimized by avoiding induction of seizure foci in brain regions
associated with neuropsychological function, and that greater efficacy
would be associated with a larger volume of seizure foci. These consi
derations led to placement on the right temple and on the left forehea
d. This placement was used in an open trial on 10 consecutive female i
npatients suffering from mania, depression, or mixed manic-depressive
state, 9 of whom showed severe cognitive impairment, psychosis, or bot
h. Ah patients achieved remission, indicating efficacy as likely above
93.3% as below it, and above 74% (p < 0.05); 6- to 10-week follow-up
was essentially unchanged. No cognitive morbidity was observed. Post-E
CT mini-mental status score averaged 28.4 out of 30, with an average i
mprovement of 17.3 points, substantially better than reported after bi
frontotemporal ECT. These results justify further consideration of thi
s placement.