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Effects of modifying the electrode placement and pulse width on cognitive side effects with unilateral ECT: A pilot randomised controlled study with computational modelling

Martin DM 1 , Bakir AA 2 , Lin F 3 , Francis-Taylor R 4 , Alduraywish A 5 , Bai S 6 Show all authors , Hadzi-Pavlovic D 4 , Dokos S 6 , Loo CK 7

Affiliations 

  • 1 Black Dog Institute, Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia. Electronic address: [email protected]
  • 2 Graduate School of Biomedical Engineering, University of New South Wales, NSW, Australia; University of Southampton Malaysia Campus, Iskandar Puteri, Johor, Malaysia
  • 3 Black Dog Institute, Sydney, NSW, Australia
  • 4 School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
  • 5 Graduate School of Biomedical Engineering, University of New South Wales, NSW, Australia; College of Applied Medical Sciences, Majmaah University, Saudi Arabia
  • 6 Graduate School of Biomedical Engineering, University of New South Wales, NSW, Australia
  • 7 Black Dog Institute, Sydney, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia; St George Hospital, South Eastern Sydney Health, Sydney, NSW, Australia
Brain Stimul, 2021 10 06;14(6):1489-1497.
PMID: 34626843 DOI: 10.1016/j.brs.2021.09.014

Abstract

BACKGROUND: The electrode placement and pulse width for electroconvulsive therapy (ECT) are important treatment parameters associated with ECT related retrograde memory side-effects. Modification of these parameters with right unilateral (RUL) ECT may have utility for further reducing these side-effects.

OBJECTIVE: This study explored use of the frontoparietal (FP) placement for reducing retrograde memory side effects with ECT. We hypothesised that superior retrograde memory outcomes would occur with FP compared to temporoparietal (TP) placement and with ultrabrief (UB: 0.3 ms) compared to brief pulse (BP: 1.0 ms) width ECT.

METHODS: In this randomised cross-over, double-blinded study, participants received a single treatment of BP TP, BP FP, UB TP and UB FP ECT. Neuropsychological testing was conducted prior to and immediately following each treatment. Computational modelling was conducted to explore associations between E-fields in regions-of-interest associated with memory.

RESULTS: Nine participants completed the study. The FP placement was not superior to TP for retrograde memory outcomes. For both electrode placements UB pulse width was associated with significantly better visual retrograde memory compared to BP (p 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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