Effectiveness of Switching to Right Unilateral From Bilateral Stimulation in Patients With Inadequate Seizures During Acute Electroconvulsive Therapy.

AIM: To determine the effectiveness of switching to right unilateral (RUL) from bilateral (BL) stimulation in patients with inadequate seizures during acute electroconvulsive therapy (ECT).

METHODS

A retrospective review of medical records was conducted of patients admitted to the Department of Psychiatry, Hiroshima Citizens Hospital, who received acute ECT from January 2019 to December 2021. Clinical characteristics including ECT procedures and adverse events were examined in patients who switched to RUL from BL.

RESULTS

Thirteen patients (7 male and 6 female patients, 66-89 years old) underwent switching to RUL from BL. The total number of ECT sessions including those for seizure titration per patient ranged from 10 to 31, whereas after switching, the number of RUL ECT sessions ranged from 2 to 18. Adequate seizure stimulation was observed from 0 to 11 sessions in patients who underwent RUL. The titrated seizure threshold for RUL was 25.2 mC in 3, 50.4 mC in 8, 75.6 mC, and 100.8 mC in 1. Clinical improvement, assessed by Clinical Global Impressions-Improvement score, was noted in all patients after switching. At the end of the acute ECT course, which included concurrent oral theophylline augmentation in 4 and shortened pulse width in 1 patient, the Clinical Global Impressions-Improvement score was very much improved in 9 and much improved in 3. All 13 patients finished the scheduled ECT course.

CONCLUSION

Switching to RUL from BL can be considered as an effective treatment option for patients undergoing ECT with inadequate seizures.