J Korean Neuropsychiatr Assoc.  2020 Nov;59(4):311-318. 10.4306/jknpa.2020.59.4.311.

Initial Seizure Threshold in Ultra-Brief Pulse Width Right Unilateral Electroconvulsive Therapy

  • 1Department of Psychiatry and Electroconvulsive Therapy Center, Dongguk University International Hospital, Goyang, Korea
  • 2Department of Psychiatry, Dongguk University Graduate School, Goyang, Korea
  • 3Department of Psychiatry, Daejeon Eulji Medical Center, Eulji University, Daejeon, Korea
  • 4Department of Psychiatry, Nowon Eulji Medical Center, Eulji University, Seoul, Korea


The present study investigates the initial seizure threshold (IST) of an ultra-brief pulse width right unilateral electroconvulsive therapy (UBP-RUL ECT) in Korean patients with mental disorders to identify its predictive factors for clinical improvement.
This study includes thirty patients who received 0.3-ms UBP-RUL ECT using upward titration to measure IST after the use of general anesthesia and muscle relaxation between December 2015 and June 2020. During the second session, the amount of charge that ranged between 500% to 600% of IST was applied as the stimulus intensity (SI). Demographic and clinical information was gathered from electronic medical records, and a stepwise variable selection was conducted to identify the relevant predictors of IST.
The mean age of study subjects was 49.7±18.3 years, and 12 (40.0%) patients were male. The mean IST and SI were 31.6±17.2 mC and 176.0±98.5 mC, respectively, which did not differ between males and females. The mean scores of the Clinical Global Impression-severity and the Clinical Global Impression-improvement before and after acute ECT were 5.8±0.8 and 2.1±0.7, respectively. The age and anesthetic dose per body weight were significant predictors of IST. However, the IST and SI were not associated with clinical improvement.
The present study demonstrated that the IST distribution for UBP-RUL ECT in Korean patients with mental disorders was comparable to those reported in previous literature. The IST was associated with age and anesthetic dose.


Mental disorder; Electroconvulsive therapy; Initial seizure threshold; Ultra-brief pulse width; Right unilateral electrode placement
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