Right unilateral ultrabrief pulse electroconvulsive therapy as an augmentation strategy

Abstract

To ensure good clinical efficacy following electroconvulsive therapy (ECT), adequate therapeutic seizures must be induced using a stimulus intensity that appropriately exceeds seizure threshold. However, it is not uncommon to fail to elicit adequate therapeutic seizures even at the maximum stimulus charge. Right unilateral ultrabrief pulse (RUL-UBP) ECT is an emerging treatment option demonstrating evidence of reduced cognitive side effects. Previous studies have demonstrated that seizure threshold is lower in patients treated with RUL-UBP ECT than in those treated with conventional ECT. For this reason, RUL-UBP ECT may be beneficial for patients in whom seizure induction is difficult with conventional ECT. This case report illustrates a patient suffering from catatonic schizophrenia in whom bilateral brief pulse ECT failed to induce seizures at the maximum charge. However, RUL-UBP ECT successfully elicited therapeutic seizures and enabled the patient to achieve complete remission. Switching to RUL-UBP ECT could be a new alternative for seizure induction in clinical practice.