Right unilateral electroconvulsive therapy at six times seizure threshold.
OBJECTIVE
To examine the clinical practice of right unilateral electroconvulsive therapy (ECT) administered at six times seizure threshold (6 x RUL ECT).


METHODS
A retrospective review of all patients who received 6 x RUL ECT between July 2000 and June 2002.


RESULTS
Twenty-one patients across a range of ages and diagnostic groups received D'Elia unilateral ECT at a seizure dosage at or above 388.8 milliCoumbs (mC). In order to sustain predetermined criteria for seizure adequacy, energy was increased in 71% of patients. Final seizure lengths of 45 s electroencephalographic (EEG) activity, 28 s motor activity (cuffed) and a post-ictal suppression index (PSI) of 83% were recorded. Eighty percent of patients responded after a mean of 7.0 treatments. Cognitive side-effects were noted in 21% of patients. Fifty-two percent relapsed on average 6.3 months after the last treatment despite continuation pharmacotherapy.


CONCLUSIONS
6 x RUL ECT was found to be clinically effective, associated with cognitive side-effects and relapse. The debate over electrode placement is likely to continue.
Little
John D
JD
Gampians Psychiatric Services, Ballarat, Victoria, Australia. johnl@bhs.grampianshealth.org.au
Munday
Jo
J
Lyall
Gordon
G
Greene
Dennis
D
Chubb
Graeme
G
Orr
Michelle
M
D000328:Adult; D000368:Aged; D004565:Electroconvulsive Therapy / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D012640:Seizures / Q000628:therapy*; D016896:Treatment Outcome