Electroconvulsive therapy electrode placement

Electroconvulsive therapy may be administered using unilateral or bilateral electrode placement. Either mode requires consideration of seizure threshold. Several studies involving adults have shown that neither age nor other demographic variables are good predictors of seizure threshold (Coffey et ah, 1995 Enns and Kar-velas, 1995). Knowledge of seizure threshold may be... 

Nobler MS, Sackeim HA Augmentation strategies in electroconvulsive therapy a synthesis. Convulsive Therapy 9 331-351, 1993 Nobler MS, Sackeim HA Electroconvulsive therapy clinical and biological aspects, in Prediction of Treatment Response in Mood Disorders. Edited by Goodnick P. Washington, DC, American Psychiatric Press, 1996, pp 177-198 Nobler MS, Sackeim HA, Solomou M, et al EEG manifestations during ECT effects of electrode placement and stimulus intensity. Biol Psychiatry 34 321-330, 1993 Nobler MS, Sackeim HA, Prohovnik 1, et al Regional cerebral blood flow in mood disorders. III treatment and clinical response. Arch Gen Psychiatry 51 884-897, 1994... 

Sackeim HA, Decina P, Kanzler M, et al Effects of electrode placement on the efficacy of titrated, low-dose ECT. Am J Psychiatry 144 1449-1455, 1987a Sackeim HA, Decina P, Prohovnik 1, et al Seizure threshold in electroconvulsive therapy. Effects of sex, age, electrode placement, and number of treatments. Arch Gen Psychiatry 44 355-360, 1987b... 

When the results from several studies are converted into similar units, a simple inspection of a graph or table readily reveals which studies have different outcomes from the majority. Such discrepancies can also be examined by a variety of statistical indices. For example, one can calculate a statistical index of homogeneity, remove the most discrepant study, and recalculate, revealing that all but one study is homogenous. If two studies are discrepant, one could remove both and again reexamine the indices of homogeneity, and so on. For an example, we summarize the relative efficacy of unilateral nondominant versus bilateral electrode placement for the administration of electroconvulsive therapy (ECT). Here, 10 studies had one result, and two others a different outcome (see Table 8-10 and Table 8-11, in Chapter 8). 

Sackeim HA, Pmdic J, Devanand DP, et al. Effects of stimulus intensity and electrode placement on efficacy and cognitive effects of electroconvulsive therapy. N Engl J Med 1993 328 839-846. 

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