Comparison of three right-unilateral electroconvulsive therapy montages

The efficacy and cognitive outcomes of electroconvulsive therapy (ECT) on psychiatric disorders have been shown to depend on variations in electrode montages. Conventionally, the right-unilateral (RUL) montage was temporoparietal, originally proposed by d´Elia. Although it was reported to have better cognitive outcomes than the bitemporal montage, it is still associated with substantial memory side effects. Two other RUL montages utilizing a frontal electrode, also proposed by d´Elia, may be more beneficial. In order to investigate this, a high resolution finite element human head model was generated from MRI scans and implemented with tissue heterogeneity. The model was used to compare the effects of three different d´Elia RUL montages. The results suggest that the two alternative placements are likely to result in lesser memory side effects, and may have useful efficacy.