Recovery of orientation after electroconvulsive therapy

Studies which provide quantitative analyses of postictal disorientation following electroconvulsive therapy (ECT) are reviewed with emphasis on the variable of time since seizure induction as it relates to recovery of orientation. The studies make it clear that separable components of orientation (person, place, and time) recover at different rates following ECT. The length of disorientation tends to increase with treatment number, but modifications of electrode placement (nondominant unilateral ECT) and electrical stimulus waveform (brief-pulse ECT) result in a decrease in disorientation when compared to standard bilateral sinusoidal ECT. Bilateral ECT may produce more disorientation than dominant unilateral ECT if more generalized seizures occur with the former than the latter treatment modality. Practical implications of these issues are discussed.