Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial

Kellner, Charles H.; Knapp, Rebecca G.; Husain, Mustafa M.; Rasmussen, Keith G.; Sampson, Shirlene; Cullum, C. Munro; McClintock, Shawn M.; Tobias, Kristen G.; Martino, Celena; Mueller, Martina; Bailine, Samuel H.; Fink, Max; Petrides, Georgios

doi:10.1192/bjp.bp.109.066183

Cited by 332 publications

(293 citation statements)

References 32 publications

(25 reference statements)

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“…Most experimental work over the past 3 decades has focused primarily on optimizing ECT treatment parameters (eg, electrode placement, stimulus dose, and pulse width) to produce the best possible balance between clinical and neuropsychological outcomes. These studies unequivocally show that ECT is a powerful treatment option capable of producing full remission where other treatments have failed (Dunne and McLoughlin, 2012;Eranti et al, 2007;Kellner et al, 2010;Loo et al, 2012;Sackeim et al, 2009). However, given that relapse following ECT is a key clinical problem, we carried out a systematic review of all existing evidence, randomized and observational, to provide an overview of current knowledge on this important question.…”

Section: Introductionmentioning

confidence: 99%

“…Electroconvulsive therapy (ECT) is a highly effective acute treatment for major depression (Eranti et al, 2007;Kellner et al, 2010;The UK ECT Review Group, 2003). Although remission rates exceed those seen with other somatic treatments, high rates of relapse, especially early relapse, are observed and acknowledged as a major clinical problem (Kellner et al, 2006;Sackeim et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

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Relapse Following Successful Electroconvulsive Therapy for Major Depression: A Meta-Analysis

Jelovac

Kolshus

McLoughlin

2013

Neuropsychopharmacol

199

155

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High rates of early relapse following electroconvulsive therapy (ECT) are typically reported in the literature. Current treatment guidelines offer little information to clinicians on the optimal nature of maintenance therapy following ECT. The aim of this study was to provide a systematic overview of the existing evidence regarding post-ECT relapse. A keyword search of electronic databases was performed for studies appearing in the peer-reviewed literature before January 2013 reporting on relapse rates in responders to an acute course of ECT administered for a major depressive episode. Meta-analyses were performed where appropriate. Thirty-two studies with up to 2 years' duration of follow-up were included. In modern era studies of continuation pharmacotherapy, 51.1% (95% CI ¼ 44.7-57.4%) of patients relapsed by 12 months following successful initial treatment with ECT, with the majority (37.7%, 95% CI ¼ 30.7-45.2%) relapsing within the first 6 months. The 6-month relapse rate was similar in patients treated with continuation ECT (37.2%, 95% CI ¼ 23.4-53.5%). In randomized controlled trials, antidepressant medication halved the risk of relapse compared with placebo in the first 6 months (risk ratio ¼ 0.49, 95% CI ¼ 0.39-0.62, po0.0001, number needed to treat ¼ 3.3). Despite continuation therapy, the risk of relapse within the first year following ECT is substantial, with the period of greatest risk being the first 6 months. The largest evidence base for efficacy in post-ECT relapse prevention exists for tricyclic antidepressants. Published evidence is limited or non-existent for commonly used newer antidepressants or popular augmentation strategies. Maintenance of well-being following successful ECT needs to be improved.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Relapse Following Successful Electroconvulsive Therapy for Major Depression: A Meta-Analysis

Jelovac

Kolshus

McLoughlin

2013

Neuropsychopharmacol

199

155

View full text Add to dashboard Cite

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“…However, previous studies found that though bilateral ECT is faster and more effective than other electrode placements, it is also associated with greater cognitive side effects (Carney et al, 2003;Kennedy et al, 2009). Kellner et al (2010a) did not detect differences in the cognitive profi le of bifrontal ECT compared to bitemporal ECT. When used with optimal doses, different electrode placements show modest differences in effi cacy, clinicians need to consider whether a modest benefi t in favour of rapid treatment or in favour of minimizing possible cognitive side effects is preferred, depending on individual patient needs (Kellner et al, 2010b).…”

Section: How Should Treatment Be Delivered?mentioning

confidence: 87%

“…A multi-centre randomized, double-blind, controlled trial investigated bifrontal, bitemporal and right unilateral electrode placement in ECT (Kellner et al, 2010a). All three electrode placements resulted in clinically and statistically signifi cant antidepressant outcomes: remission rates were 55% (95%CI 43 -66%) with right unilateral, 61% with bifrontal (95%CI 50 -71%) and 64% (95%CI 53 -75%) with bitemporal electrode positioning.…”

Section: How Should Treatment Be Delivered?mentioning

confidence: 99%

The Use of ECT and MST in treating depression

Allan

Ebmeier

2011

International Review of Psychiatry

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Electroconvulsive therapy (ECT) has been used clinically since 1938. Its most common use is in the treatment of depression: fi rst line treatment where rapid recovery is a priority, but more frequently as an effective treatment for patients who do not respond to pharmacological and psychological approaches. Whilst it is widely hailed as an effective treatment, concerns about its effect on cognition remain. The development of magnetic seizure therapy (MST) over the past decade has attempted to devise a therapy with comparable effi cacy to ECT, but without the associated cognitive side effects. The rationale for this is that MST uses magnetic fi elds to induce seizures in the cortex, without electrical stimulation of brain structures involved with memory. MST has been used successfully in the treatment of depression, yet there is a dearth of literature in comparison with ECT. We present a systematic review of the literature on ECT (from 2009ECT (from -2011 and MST (from 2001MST (from -2011.

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“…These modifications reduced the intensity and duration of the electrical stimulus and made it more focal (Lee et al, 2012;Peterchev et al, 2010b;Sackeim, 2004;Sackeim et al, 1994). Nevertheless, a significant proportion of patients receiving ECT still experience adverse effects, which impedes the broader application of this highly effective intervention (Goodman, 2011;Kellner et al, 2010;Semkovska and McLoughlin, 2010;Verwijk et al, 2012). Furthermore, despite the demonstrated utility of ST titration in improving the efficacy and tolerability of ECT, ST titration still has not been uniformly adopted.…”

Section: Introductionmentioning

confidence: 99%

Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy

Peterchev

Krystal

Rosa³

et al. 2015

Neuropsychopharmacol

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Electroconvulsive therapy (ECT) at conventional current amplitudes (800-900 mA) is highly effective but carries the risk of cognitive side effects. Lowering and individualizing the current amplitude may reduce side effects by virtue of a less intense and more focal electric field exposure in the brain, but this aspect of ECT dosing is largely unexplored. Magnetic seizure therapy (MST) induces a weaker and more focal electric field than ECT; however, the pulse amplitude is not individualized and the minimum amplitude required to induce a seizure is unknown. We titrated the amplitude of long stimulus trains (500 pulses) as a means of determining the minimum current amplitude required to induce a seizure with ECT (bilateral, right unilateral, bifrontal, and frontomedial electrode placements) and MST (round coil on vertex) in nonhuman primates. Furthermore, we investigated a novel method of predicting this amplitude-titrated seizure threshold (ST) by a non-convulsive measurement of motor threshold (MT) using single pulses delivered through the ECT electrodes or MST coil. Average STs were substantially lower than conventional pulse amplitudes (112-174 mA for ECT and 37.4% of maximum device amplitude for MST). ST was more variable in ECT than in MST. MT explained 63% of the ST variance and is hence the strongest known predictor of ST. These results indicate that seizures can be induced with less intense electric fields than conventional ECT that may be safer; efficacy and side effects should be evaluated in clinical studies. MT measurement could be a faster and safer alternative to empirical ST titration for ECT and MST.

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Bifrontal, bitemporal and right unilateral electrode placement in ECT: randomised trial

Cited by 332 publications

References 32 publications

Relapse Following Successful Electroconvulsive Therapy for Major Depression: A Meta-Analysis

Relapse Following Successful Electroconvulsive Therapy for Major Depression: A Meta-Analysis

The Use of ECT and MST in treating depression

Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy

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