Low amplitude pulse seizure therapy (LAP-ST): a form of seizure therapy with potential for reduced cognitive and memory side effects - a narrative review

Low Amplitude Seizure Therapy (LAP-ST) is a modification of electroconvulsive therapy (ECT) in which current amplitude is reduced below the 800-900 mA used by contemporary current-constant devices. Preliminary studies have investigated whether this approach can retain therapeutic effects while reducing cognitive adverse effects.

The authors review the historical origins of low-amplitude convulsive stimulation, the electric-field rationale for amplitude reduction, and clinical evidence for LAP-ST. We searched PubMed, MEDLINE, EMBASE and PsycINFO (inception to May 2026) and hand-searched historical sources and reference lists. The authors give review to an identified pilot case series, two open-label studies (feasibility; proof-of-concept), two double-blind randomized trials (one a pilot reported across three publications) and a prospective amplitude-titration trial, alongside finite-element modeling studies, which are included herein.

Low pulse amplitude was used to elicit therapeutic seizures decades before fixed-current devices became standard. Pilot LAP-ST trials found no clear differences in antidepressant or anti-suicidal outcomes versus standard right-unilateral ultra-brief ECT and report shorter post-ictal reorientation times. Reorientation time is the strongest predictor of retrograde autobiographical memory change after ECT, though not direct evidence of preserved memory. Larger, adequately powered randomized trials are needed, ideally combining low amplitude with ultra-brief pulses, focal electrode placement and individualized E-field-informed dosing.