Fine-tuning electroconvulsive therapy: A cognitive comparison of brief and ultra-brief pulse widths
DOI:
https://doi.org/10.71152/ajms.v16i7.4569Keywords:
Electroconvulsive therapy; Cognitive adverse effects; Pulse duration; Ultra brief pulse; Modified electroconvulsive therapy; Cognition disordersAbstract
Background: Electroconvulsive therapy (ECT) has been a cornerstone in managing severe psychiatric illnesses. However, concerns about its cognitive side effects have led to evolving techniques aimed at minimizing cognitive impairments. Specifically, the use of ultra-brief pulse width (0.5 ms) compared to brief pulse width (1.5 ms) in bitemporal modified ECT (MECT) offers a promising avenue for cognitive preservation.
Aims and Objectives: To compare the cognitive outcomes associated with brief and ultra-brief pulse widths in bitemporal MECT.
Materials and Methods: This prospective, randomized comparative study was conducted at a rural tertiary care hospital in Northern India. Sixty-six patients aged 18–60 years, diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, or severe depression, were randomly assigned to receive either brief or ultra-brief pulse MECT. Cognitive functions were assessed using standardized tools, including the Hindi mental status examination and Battery for ECT-related cognitive deficits. Pre- and post-treatment evaluations were compared to determine changes in cognitive performance.
Results: Both groups exhibited some level of cognitive change following treatment. However, patients receiving ultra-brief pulse MECT demonstrated significantly better preservation of cognitive functions, notably in memory retention, attention, and executive functioning (P<0.05). Domains such as verbal learning, processing speed, and short-term recall were notably less affected in the ultra-brief group compared to the brief pulse group.
Conclusion: Ultra brief pulse width in bitemporal MECT appears to offer a cognitive advantage over brief pulse width, suggesting it may be the preferred choice when cognitive preservation is a clinical priority.
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