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Ultrabrief (0.3 ms) or Brief (0.5 ms) Pulses for Right Unilateral Electroconvulsive Therapy: Is There a Difference in Seizure Thresholds?

Rosa, Moacyr A. MD, PhD*†; Bueno, Celso R. MD; Andrade, Marco A. MD*†; Abdo, Guilherme L. MD*†; Rosa, Marina O. MS, MD

doi: 10.1097/YCT.0b013e31827134ba
Original Studies

Objectives: To compare the minimum charge to elicit a seizure using 2 different pulse widths, the brief pulse (0.5 milliseconds [ms]) and the ultrabrief pulse (0.3 ms).

Methods: We compared retrospectively the last 30 patients in our ECT unit whose seizure thresholds were titrated using a pulse width of 0.5 ms to the last 30 patients whose seizure thresholds were titrated using a pulse width of 0.3 ms. The former were regular clinical patients, and the latter were participating in a clinical trial on the use of ultrabrief pulse treatment. All titrations were performed with right unilateral electrode positioning. Most patients continued to use psychotropic medications.

Results: Initial seizure threshold (as measured in millicoulombs [mC]) for the brief pulse group (0.5 ms) was 16 (n = 1); 32 (n = 21), and 64 (n = 8); whereas for the ultrabrief pulse group (0.3 ms), it was 9.2 (n = 3), 38.4 (n = 21), 19.2 (n = 3), 76.8 (n = 2), and 307.2 (n = 1). Excluding the outlier, there was no statistical difference between mean seizure thresholds.

Conclusions: If we exclude the outlier from the ultrabrief group (seizure threshold [ST], 307 mC), we can observe that most of the patients in both groups had an ST between 30 and 40 mC. No patient in the brief pulse group showed a lower ST than 16 mC, probably because this was the first step of titration for this group. The data suggest that the difference between 0.3 and 0.5 ms may not be big, although randomized prospective studies with a more precise and similar steps used for titration are needed. Clinical efficacy was not compared in the present study.

From the *Federal University of São Paulo, São Paulo, Brazil; †Instituto de Pesquisas Avançadas em Neuroestimulação (IPAN), Sao Paulo, Brazil and ‡University of São Paulo, São Paulo, Brazil.

Received for publication February 13, 2012; accepted August 3, 2012.

Reprints: Moacyr A. Rosa, MD, PhD, Rua Vergueiro, 1855 cj. 46, São Paulo, SP, CEP 04101-000 Brazil (e-mail: or

A grant from “Fundação de Amparo à Pesquisa do Estado de São Paulo–FAPESP” No. 2006/03419-9 was received to acquire a SpECTrum 5000Q machine.

The authors have no conflicts of interest or financial disclosures to report.

© 2013 Lippincott Williams & Wilkins, Inc.