Asymmetric bilateral right frontotemporal left frontal stimulus electrode placement for electroconvulsive therapy

The development is described of a new stimulus electrode placement for electroconvulsive therapy (ECT) from expectations that relate the location and volume of induced seizure foci to side effects and efficacy, respectively. These expectations are that cognitive side effects would be minimized by avoiding induction of seizure foci in brain regions associated with neuropsychological function, and that greater efficacy would be associated with a larger volume of seizure foci. These considerations led to placement on the right temple and on the left forehead. This placement was used in an open trial on 10 consecutive female inpatients suffering from mania, depression, or mixed manic-depressive state, 9 of whom showed severe cognitive impairment, psychosis, or both. All patients achieved remission, indicating efficacy as likely above 93.3% as below it, and above 74% (p < 0.05); 6- to 10-week follow-up was essentially unchanged. No cognitive morbidity was observed. Post-ECT mini-mental status score averaged 28.4 out of 30, with an average improvement of 17.3 points, substantially better than reported after bifrontotemporal ECT. These results justify further consideration of this placement.