title: Controlling stimulation strength and focality in electroconvulsive therapy via current amplitude and electrode size and spacing: comparison with magnetic seizure therapy.
abstract: OBJECTIVE
  Understanding the relationship between the stimulus parameters of electroconvulsive therapy (ECT) and the electric field characteristics could guide studies on improving risk/benefit ratio. We aimed to determine the effect of current amplitude and electrode size and spacing on the ECT electric field characteristics, compare ECT focality with magnetic seizure therapy (MST), and evaluate stimulus individualization by current amplitude adjustment.
  
  
  METHODS
  Electroconvulsive therapy and double-cone-coil MST electric field was simulated in a 5-shell spherical human head model. A range of ECT electrode diameters (2-5 cm), spacing (1-25 cm), and current amplitudes (0-900 mA) was explored. The head model parameters were varied to examine the stimulus current adjustment required to compensate for interindividual anatomical differences.
  
  
  RESULTS
  By reducing the electrode size, spacing, and current, the ECT electric field can be more focal and superficial without increasing scalp current density. By appropriately adjusting the electrode configuration and current, the ECT electric field characteristics can be made to approximate those of MST within 15%. Most electric field characteristics in ECT are more sensitive to head anatomy variation than in MST, especially for close electrode spacing. Nevertheless, ECT current amplitude adjustment of less than 70% can compensate for interindividual anatomical variability.
  
  
  CONCLUSIONS
  The strength and focality of ECT can be varied over a wide range by adjusting the electrode size, spacing, and current. If desirable, ECT can be made as focal as MST while using simpler stimulation equipment. Current amplitude individualization can compensate for interindividual anatomical variability.
authors.affiliation: From the *Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC; †Department of Electrical Engineering, Columbia University, New York, NY; ‡Departments of Psychology and Neuroscience, §Biomedical Engineering; and ║Electrical and Computer Engineering, Duke University, Durham, NC.
authors.forename: Zhi-De
authors.initials: ZD
authors.lastname: Deng
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Lisanby
authors.forename: Angel V
authors.initials: AV
authors.lastname: Peterchev
mesh_terms: D001921:Brain; D004565:Electroconvulsive Therapy / Q000295:instrumentation / Q000379:methods*; D004566:Electrodes; D004574:Electromagnetic Fields; D020342:Finite Element Analysis; D006257:Head; D006801:Humans; D008953:Models, Anatomic; D008959:Models, Neurological; D050781:Transcranial Magnetic Stimulation / Q000295:instrumentation / Q000379:methods*