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A systematic review and computational modelling analysis of unilateral montages in electroconvulsive therapy
Author(s) -
Martin D.,
Lin F.,
Bai S.,
Moffa A.,
Taylor R.,
Nikolin S.,
Bull M.,
Dokos S.,
Loo C. K.
Publication year - 2019
Publication title -
acta psychiatrica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.849
H-Index - 146
eISSN - 1600-0447
pISSN - 0001-690X
DOI - 10.1111/acps.13089
Subject(s) - electroconvulsive therapy , cognition , psychology , scopus , significant difference , medicine , physical medicine and rehabilitation , clinical psychology , medline , psychiatry , political science , law
Objective To examine the clinical outcomes of ECT unilateral placements compared in prior studies and apply insights from computational modelling to understand differences between placements. Methods PubMed, Embase, Scopus and Psyc INFO and reference lists were systematically searched for studies of depressed patients where two unilateral placements were compared and clinical outcomes were reported. Computational modelling was done to generate electric field maps for each unilateral placement identified in the systematic review. Results A total of 29 studies met criteria for inclusion. Eight studies reported efficacy outcomes and 23 studies reported cognitive outcomes. Most studies found no significant difference in efficacy between right unilateral ( RUL ) and left unilateral ( LUL ) ECT , and no difference was found between temporo‐parietal and fronto‐temporal ECT . For the majority of studies, RUL placements had better verbal anterograde memory outcomes compared with the LUL placements. There was some evidence suggestive of cognitive advantages for fronto‐frontal and fronto‐parietal placements relative to temporo‐parietal ECT . Conclusions For efficacy, studies mainly focused on the comparison of right vs. left hemispheric stimulation, with the available evidence suggesting no substantive difference. RUL placements tended to have better verbal anterograde memory outcomes relative to LUL placements, though limited differences were found between the RUL placements.