Speech dominance, handedness and electro-convulsions

This paper discusses methods for assessing speech dominance in cases for unilateral ECT. The use of formal laterality tests has been strongly advocated in the literature, but is seldom adopted in clinical practice. Assessment of handwriting type (left/right, inverted/non-inverted) has been put forward as an alternative, but is not valid. Consideration of handedness alone is the most common practice, but is of little value. From current evidence on the relation of handedness to speech dominance, the paper evaluates the likely outcomes of always administering right-sided ECT, and of giving formal tests to left-handers only.