Cognitive Consequences of Low‐Dosage Electroconvulsive Therapy a

Standard electroconvulsive therapy (ECT) procedures, as a consequence of general anesthesia, muscle relaxation, and the elicitation of generalized seizure, result inevitably in loss of consciousness and of spontaneous respiration. Following the ECT-induced seizure, as with spontaneous generalized seizures and most acute brain injuries and head traumas, there is a variable period of disorientation. The duration of the period of disorientation following ECT appears to be exquisitely sensitive to treatment parameters, including modality or electrode placement (unilateral/ bilateral); dosage of electrical stimulation and/or stimulus waveform; cumulative treatment number; and temporal spacing of treatments.'-' With the recovery of orientation during the acute postictal period, patients manifest a variety of neuropsychological deficits. Retrograde memory, usually operationalized as memory for information presented just prior to the treatment, and anterograde memory, usually operationalized as memory for information presented following seizure elicitation, are often grossly disturbed! Postictal deficits have been reported for other aspects of memory functioning, particularly semantic memory? More broadly, there has been relatively little investigation of possible acute postictal effects of ECT on aspects of perceptual-cognitive functioning other than memory. Nonetheless, there is evidence that ECT may temporarily disrupt basic attentional processes, as assessed by simple cancellation procedures,6 and may alter perceptual thresholds and the localization of sound in space.' It appears that the cognitive deficits induced by ECT are typically most intense during the acute postictal period. Repeated testing at time points further removed from the seizure has demonstrated rapid recovery However, with traditional