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Inducing adequate therapeutic seizures during electroconvulsive therapy is sometimes difficult, even at the maximum stimulus charge, due to a high seizure threshold. Here, we describe two patients with very poor seizure responses at the maximum charge using conventional stimulus parameters in whom responses were successfully augmented by widening the pulse width at the same or even lower stimulus charge. This strategy could be an additional option for seizure augmentation in clinical practice. The potential clinical utility of stimulus parameter modifications should be further investigated.

Elongation of pulse width as an augmentation strategy in electroconvulsive therapy