Traditionally it has been thought that a grand mal seizure is both necessary and sufficient for the maximum efficacy of ECT. Recent important research, however, has demonstrated that both the electrical dosage above the seizure threshold, i.e. the suprathreshold dosage, and the electrode placement (unilateral or bilateral) determine the efficacy of this treatment, as well as the degree of cognitive impairment. This article reviews the development of these significant concepts and suggests specific practical recommendations for incorporating these into contemporary ECT practice.
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