ReviewsIs There Evidence That Stimulus Parameters and Electrode Placement Affect the Cognitive Side Effects of Electroconvulsive Therapy in Patients With Schizophrenia and Schizoaffective Disorder? A Systematic ReviewCicek, Mustafa MD∗,†; McCall, William V. MD, MS‡; Yao, Zhixing MD‡; Sackeim, Harold A. PhD§; Rosenquist, Peter MD‡; Youssef, Nagy A. MD, PhD‡,∥ Author Information From the ∗Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich †Psychiatrisches Zentrum Appenzell Ausserrhoden, Herisau, Switzerland ‡Department of Psychiatry & Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA §Departments of Psychiatry and Radiology, Columbia University, New York, NY ∥Dwight Eisenhower Army Medical Center, Ft. Gordon, GA. Received for publication January 31, 2020; accepted October 14, 2020. Reprints: Nagy A. Youssef, MD, PhD, Department of Psychiatry and Human Behavior, Medical College of Georgia at Augusta University 997 St. Sebastian Way, Augusta, GA 30912 (e-mail: [email protected]). Conflicts of Interest: N.A.Y. receives research support from MECTA Corp, Merck and Vistagen, the Department of Veteran Affairs and The Augusta Biomedical Research Corporation. N.A.Y. received Speaker CME honoraria from the Georgia Department of Behavioral Health and Developmental Disabilities (DHBDD) and Psychiatric Annals for unrelated CME topics. W.V.MC. receives research support from MECTA and Merck and Vistagen; royalties from Wolters Kluwer; scientific advisor for sage and jazz; speakers bureau for CME Outfitters. H.A.S. is the inventor on a patent for FEAST (US8712532 B2) and serves as a consultant to the MECTA Corporation and Neuronetics, Inc. Disclaimer: The views expressed are those of authors and do not represent Medical College of Georgia or the United States Government. The Journal of ECT: June 2021 - Volume 37 - Issue 2 - p 133-139 doi: 10.1097/YCT.0000000000000737 Buy Metrics Abstract Seventy percent of patients with treatment-resistant schizophrenia do not respond to clozapine. Electroconvulsive therapy (ECT) can potentially offer significant benefit in clozapine-resistant patients. However, cognitive side effects can occur with ECT and are a function of stimulus parameters and electrode placements. Thus, the objective of this article is to systematically review published clinical trials related to the effect of ECT stimulus parameters and electrode placements on cognitive side effects. We performed a systematic review of the literature up to July of 2020 for clinical studies published in English or German examining the effect of ECT stimulus parameters and/or electrode placement on cognitive side effects in patients with schizophrenia or schizoaffective disorder. The literature search generated 3 randomized, double-blind, clinical trials, 1 randomized, nonblinded trial, and 1 retrospective study. There are mixed findings regarding whether pulse width and stimulus dose impact on cognitive side effects. One study showed less cognitive side effect for right unilateral (RUL) than bitemporal (BT) electrode placement, and 2 studies showed a cognitive advantage for bifrontal (BF) compared with BT ECT. Only 1 retrospective study measured global cognition and showed post-ECT cognitive improvement with all treatment modalities using Montreal Cognitive Assessment in comparison to pre-ECT Montreal Cognitive Assessment scores. Current data are limited, but evolving. The evidence suggests that RUL or BF ECT have more favorable cognitive outcomes than BT ECT. Definitive larger clinical trials are needed to optimize parameter and electrode placement selection to minimize adverse cognitive effects. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.