Comparison of clinical efficacy and side effects for bitemporal and bifrontal electrode placement in electroconvulsive therapy.
OBJECTIVE
Bifrontal (BF) placement of electrodes in electroconvulsive therapy (ECT) has become a popular alternative to bitemporal (BT) placement. This study compares the clinical efficacy, side effects, and rehospitalization rates of BT and BF electrode placement in a community hospital setting.


METHODS
Charts from 76 patients receiving ECT treatments at Harborview Medical Center from 1994 to 2000 were reviewed to extract data on the characteristics of the course of ECT, clinical response, total headaches, narcotic and nonsteroidal anti-inflammatory drug doses, as well as documentation of confusion, disorientation, memory loss, and treatment emergent need for assistance with activities of daily living.


RESULTS
The BT patients experienced more clinical improvement during their stay (a 7-point greater change in Psychiatric Symptom Assessment Scale score, P < 0.05) and were significantly less likely to be rehospitalized within a 1-year time frame (odds ratio = 4.9, P = <0.05), even after controlling for relevant covariates. Although the two patient groups had equal rates of headache and analgesic administration, the BT placement caused significantly more cognitive impairment.


CONCLUSIONS
This study suggests that BT electrode placement offers better efficacy but modestly greater cognitive impairment than BF electrode placement.
Bakewell
Catherine J
CJ
University of Washington School of Medicine, Seattle, USA.
Russo
Joan
J
Tanner
Craig
C
Avery
David H
DH
Neumaier
John F
JF
D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004565:Electroconvulsive Therapy / Q000009:adverse effects / Q000379:methods*; D004566:Electrodes; D005260:Female; D005625:Frontal Lobe / Q000502:physiology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012189:Retrospective Studies; D013702:Temporal Lobe / Q000502:physiology*; D016896:Treatment Outcome