Efficacy and safety assessment of different electrode placements during electroconvulsive therapy for the treatment of depression: a comparison of bitemporal, bifrontal and unilateral right-sided stimulation - a narrative review

Current Problems of Psychiatry Pub Date : 2024-03-12 DOI:10.12923/2353-8627/2024-0003

Z. Wingralek, Katarzyna Nowak, Agnieszka Banaszek2, Piotr Jagodowski, Michał Próchnicki, H. Karakuła-Juchnowicz

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Abstract

Introduction: Consequences of depressive syndrome are changes in central nervous system, especially the reduction in volume and disturbances in neuronal metabolism. There are disturbances in cerebral blood flow, in areas responsible for concentration, memory and regulation of behaviour and emotions. ECT method has shown considerable effectiveness in treatment of depression. It has invariably remained effective as a form of treatment in psychiatry for many years. The way in which the method itself is applied and location of stimulation electrodes remains controversial. In clinical practice, bitemporal, bilateral or right unilateral applications are used, each of which activates slightly different regions in brain, resulting in different therapeutic effects. Methods: A review of available literature was performed by searching PubMed and Google Scholar databases, using the following keywords: bifrontal ECT, bitemporal ECT, right unilateral ECT, cognitive function for original papers, meta-analyses and review papers in Polish and English published from 1990 to 2022. The SANRA scale was used to maintain the high quality of the narrative review. Results: All three methods are effective in treating depressive disorders, but differ in impact on cognitive function. Bi-frontal stimulation is the most effective in emergencies, however related to a higher risk of cognitive impairment. Milder cognitive impairment, with similar therapeutic efficacy, is observed with bitemporal and unilateral placement. Conclusions: Individualised selection of ECT method is recommended, depending on patients' needs and clinical condition. The importance of individualising the dose, location of electrodes, and monitoring of cognitive function is emphasised in order to increase the effectiveness and minimise side effects. Keywords: bifrontal ECT, bitemporal ECT, right unilateral ECT, cognitive function

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电休克疗法治疗抑郁症期间不同电极位置的疗效和安全性评估：位颞、双额和单侧右侧刺激的比较--叙述性综述

简介抑郁综合征的后果是中枢神经系统发生变化，特别是体积缩小和神经元代谢紊乱。脑血流、负责集中注意力、记忆、行为和情绪调节的区域出现紊乱。电痉挛疗法在治疗抑郁症方面已显示出相当大的疗效。多年来，作为精神病学的一种治疗方式，它始终保持有效。该方法本身的应用方式和刺激电极的位置仍存在争议。在临床实践中，可采用位时、双侧或右侧单侧应用，每种方法激活的大脑区域略有不同，从而产生不同的治疗效果：方法：通过检索 PubMed 和 Google Scholar 数据库，使用以下关键词：双额叶电痉挛疗法、双颞叶电痉挛疗法、右单侧电痉挛疗法、认知功能，对 1990 年至 2022 年期间发表的波兰语和英语的原创论文、荟萃分析和综述论文进行了综述。为了保证综述的高质量，采用了SANRA量表：结果：这三种方法都能有效治疗抑郁障碍，但对认知功能的影响各不相同。双额叶刺激法在紧急情况下最为有效，但认知功能受损的风险较高。位颞部刺激和单侧刺激对认知功能的损害较轻，但疗效相似：建议根据患者的需求和临床状况，个性化选择电痉挛疗法。结论：建议根据患者的需求和临床情况，个性化选择电痉挛治疗方法，并强调剂量、电极位置和认知功能监测的个体化对于提高疗效和减少副作用的重要性。

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来源期刊

Current Problems of Psychiatry

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审稿时长

15 weeks

期刊介绍： The quarterly Current Problems of Psychiatry is a continuation of the volume "Research on Schizophrenia" and is addressed to a wide group of psychiatrists and clinical psychologists. The quarterly is a reviewed scientific journal of international scope, publishing original papers, review papers, case studies, conference reports, letters to the editor and book reviews. The aim of the "Current Problems of Psychiatry" is providing a wide audience with scientific works, representing a significant contribution to the development of psychiatry and clinical psychology. The works published in the journal are printed in Polish and English. Terms and Conditions for publishing manuscripts in the quarterly are available on the website www.cppsych.umlub.pl in the tab "Requirements".