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Revisiting Frontoparietal Montage in Electroconvulsive Therapy: Clinical Observations and Computer Modeling: A Future Treatment Option for Unilateral Electroconvulsive Therapy

Loo, Colleen K. MBBS, MD, FRANZCP*†; Bai, Siwei PhD; Martin, MClinNeuro, Donel PhD§∥; Gálvez, Verònica MBBS, MD§; Dokos, Socrates PhD

doi: 10.1097/YCT.0000000000000147
Case Reports

Objectives: The aim of this study was to compare the clinical effects of frontoparietal electrode placement, an alternative montage for right unilateral electroconvulsive therapy (ECT), with the commonly used temporoparietal montage.

Methods: In a single patient who received alternate treatments with the abovementioned right unilateral montages, within a treatment course of ECT, time-to-reorientation after each treatment and seizure expression were compared. Computer modeling was used to simulate and compare differences in electrical stimulation patterns in key cerebral regions, with the 2 montages. These simulations were done in an anatomically realistic head model recreated from magnetic resonance imaging scans of the patient’s head.

Results: Time-to-reorientation was shorter after treatment with frontoparietal ECT (mean, 28.3 minutes; SD, 2.9 minutes) than after temporoparietal ECT (mean, 50.0 minutes; SD, 11.5 minutes), suggesting less retrograde memory impairment. Seizure duration and expression were similar for the 2 montages. Computer modeling demonstrated less hippocampal and right inferior frontal cortical stimulation but comparable anterior cingulate cortex stimulation with the frontoparietal montage.

Conclusions: These results, although preliminary, suggest that the frontoparietal montage may result in less memory side effects, but comparable efficacy, to the temporoparietal montage.

From the *School of Psychiatry, University of New South Wales (UNSW), Black Dog Institute; †Department of Psychiatry, St George Hospital; ‡Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW; §School of Psychiatry, UNSW; ∥Black Dog Institute; and ¶Graduate School of Biomedical Engineering, Faculty of Engineering, UNSW, Sydney, Australia.

Received for publication March 19, 2014; accepted March 25, 2014.

Reprints: Colleen K. Loo, MBBS, MD, FRANZCP, School of Psychiatry, UNSW, Black Dog Institute, Hospital Rd, Randwick, NSW 2031, Sydney, Australia (e-mail: colleen.loo@unsw.edu.au).

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

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