Comparison of three right-unilateral electroconvulsive therapy montages

The efficacy and cognitive outcomes of electroconvulsive therapy (ECT) on psychiatric disorders have been shown to depend on variations in electrode montages. Conventionally, the right-unilateral (RUL) montage was temporoparietal, originally proposed by d'Elia. Although it was reported to have better cognitive outcomes than the bitemporal montage, it is still associated with substantial memory side effects. Two other RUL montages utilizing a frontal electrode, also proposed by d'Elia, may be more beneficial. In order to investigate this, a high resolution finite element human head model was generated from MRI scans and implemented with tissue heterogeneity. The model was used to compare the effects of three different d'Elia RUL montages. The results suggest that the two alternative placements are likely to result in lesser memory side effects, and may have useful efficacy.