Document Detail


Electroconvulsive therapy stimulus parameters: rethinking dosage.
MedLine Citation:
PMID:  20805726     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In this article, we review the parameters that define the electroconvulsive therapy (ECT) electrical stimulus and discuss their biophysical roles. We also present the summary metrics of charge and energy that are conventionally used to describe the dose of ECT and the rules commonly deployed to individualize the dose for each patient. We then highlight the limitations of these summary metrics and dosing rules in that they do not adequately capture the roles of the distinct stimulus parameters. Specifically, there is strong theoretical and empirical evidence that stimulus parameters (pulse amplitude, shape, and width, and train frequency, directionality, polarity, and duration) exert unique neurobiological effects that are important for understanding ECT outcomes. Consideration of the distinct stimulus parameters, in conjunction with electrode placement, is central to further optimization of ECT dosing paradigms to improve the risk-benefit ratio. Indeed, manipulation of specific parameters, such as reduction of pulse width and increase in number of pulses, has already resulted in dramatic reduction of adverse effects, while maintaining efficacy. Furthermore, the manipulation of other parameters, such as current amplitude, which are commonly held at fixed, high values, might be productively examined as additional means of targeting and individualizing the stimulus, potentially reducing adverse effects. We recommend that ECT dose be defined using all stimulus parameters rather than a summary metric. All stimulus parameters should be noted in treatment records and published reports. To enable research on optimization of dosing paradigms, we suggest that ECT devices provide capabilities to adjust and display all stimulus parameters.
Authors:
Angel V Peterchev; Moacyr A Rosa; Zhi-De Deng; Joan Prudic; Sarah H Lisanby
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  The journal of ECT     Volume:  26     ISSN:  1533-4112     ISO Abbreviation:  J ECT     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-31     Completed Date:  2010-12-28     Revised Date:  2014-11-02    
Medline Journal Info:
Nlm Unique ID:  9808943     Medline TA:  J ECT     Country:  United States    
Other Details:
Languages:  eng     Pagination:  159-74     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Electroconvulsive Therapy / methods*
Evoked Potentials
Humans
Neurobiology / trends
Treatment Outcome
Grant Support
ID/Acronym/Agency:
5TL1RR024158-03/RR/NCRR NIH HHS; MH60884/MH/NIMH NIH HHS; R01 MH060884/MH/NIMH NIH HHS; R01 MH060884-01/MH/NIMH NIH HHS; R01 MH060884-02/MH/NIMH NIH HHS; R01 MH060884-03/MH/NIMH NIH HHS; R01 MH060884-04/MH/NIMH NIH HHS; R01 MH060884-05/MH/NIMH NIH HHS; R01 MH060884-06/MH/NIMH NIH HHS; R01 MH060884-07/MH/NIMH NIH HHS; R01 MH060884-08/MH/NIMH NIH HHS; R01 MH060884-09/MH/NIMH NIH HHS; R01 MH091083/MH/NIMH NIH HHS; TL1 RR024158/RR/NCRR NIH HHS; TL1 RR024158-03/RR/NCRR NIH HHS
Comments/Corrections

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