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    Unilateral brief-pulse electroconvulsive therapy and cognition: Effects of electrode placement, stimulus dosage and time.

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    Authors
    Semkovska, Maria
    Keane, Deborah
    Babalola, Oyemi
    McLoughlin, Declan M
    Affiliation
    Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, James's Street, Dublin 8, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, St Patrick's University Hospital, James's Street, Dublin 8, Ireland.
    Issue Date
    2010-11-23
    
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    Citation
    Unilateral brief-pulse electroconvulsive therapy and cognition: Effects of electrode placement, stimulus dosage and time. 2010: J Psychiatr Res
    Journal
    Journal of psychiatric research
    URI
    http://hdl.handle.net/10147/128712
    DOI
    10.1016/j.jpsychires.2010.11.001
    PubMed ID
    21109254
    Abstract
    To clarify advantages of unilateral electrode placement as an optimisation technique for electroconvulsive therapy (ECT) for depression, aims were to meta-analyse unilateral ECT effects on cognitive performance relative to: (1) bitemporal electrode placement, (2) electrical dosage, and (3) time interval between final treatment and cognitive reassessment. Relevant electronic databases were systematically searched through May 2009, using the terms: "electroconvulsive therapy" and ["cogniti∗", "neuropsycholog∗", "memory", "attention", "executive", "spatial", or "intellectual"]. Inclusion criteria were: independent study of depressed patients receiving unilateral or bitemporal brief-pulse ECT; within-subjects design; use of objective cognitive assessments; available mean electrical dosage for unilateral samples. Standardized pre-post ECT weighted effect sizes were computed and pooled within 16 cognitive domains by a mixed-effects model. Thirty-nine studies (1415 patients) were meta-analysed. Up to three days after final treatment, unilateral ECT was associated with significantly smaller decreases in global cognition, delayed verbal memory retrieval, and autobiographical memory, compared to bitemporal ECT. Significant publication bias was found for autobiographical memory, favouring reporting of larger percentage loss. Higher unilateral ECT electrical dosage predicted larger decreases in verbal learning, delayed verbal memory retrieval, visual recognition, and semantic memory retrieval. When retested more than three days after completing ECT, no significant differences remained between the two electrode placements; for unilateral ECT, electrical dosage no longer predicted cognitive performance whereas increasing interval between final treatment and retesting predicted growing improvement in some variables. This interval is a more useful long-term predictor of cognitive function than electrode placement or electrical dosage following unilateral ECT.
    Item Type
    Article
    Language
    en
    ISSN
    1879-1379
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jpsychires.2010.11.001
    Scopus Count
    Collections
    St. Patrick's University Hospital

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