Controlling Stimulation Strength and Focality in Electroconvulsive Therapy via Current Amplitude and Electrode Size and Spacing: Comparison With Magnetic Seizure Therapy
Controlling Stimulation Strength and Focality in Electroconvulsive Therapy via Current Amplitude and Electrode Size and Spacing: Comparison With Magnetic Seizure Therapy
复制标题
DOI：
10.1097/yct.10.1097/yct.0b013e3182a4b4a7
复制
发表时间：
2013-12-01
期刊：
影响因子：
2.5
通讯作者：
Peterchev, Angel, V
中科院分区：
文献类型：
--
作者：
Deng Zhi-De;Lisanby, Sarah H.;Peterchev, Angel, V
目的了解电休克治疗(ECT)的刺激参数与电场特性之间的关系，有助于指导提高风险/效益比的研究。目的确定电流幅值、电极尺寸和间距对ECT电场特性的影响，比较ECT和磁惊厥治疗(MST)的局部性，并通过调整电流幅值来评估刺激个体化。方法在一个5壳球形人头模型中模拟电惊厥治疗和双锥体线圈MST电场。探索了电极直径(2-5 cm)、间距(1-25 cm)和电流幅度(0-900 mA)的范围。结果通过减小电极尺寸、间距和电流，在不增加头皮电流密度的情况下，ECT的电场可以更集中和更浅。通过适当调整电极结构和电流，可以使ECT的电场特性在15%以内接近MST的电场特性。ECT的大部分电场特征对头部解剖结构的变化比MST更敏感，尤其是在电极间距较近的情况下。然而，低于70%的ECT电流幅度调整可以补偿个体间的解剖差异。结论通过调整电极大小、间距和电流，ECT的强度和焦点可以在很大范围内变化。如果需要，在使用更简单的刺激设备的同时，ECT可以像MST一样定位。电流幅度个体化可以补偿个体间的解剖变异。
ObjectivesUnderstanding the relationship between the stimulus parameters of electroconvulsive therapy (ECT) and the electric field characteristics could guide studies on improving risk/benefit ratio. We aimed to determine the effect of current amplitude and electrode size and spacing on the ECT electric field characteristics, compare ECT focality with magnetic seizure therapy (MST), and evaluate stimulus individualization by current amplitude adjustment.MethodsElectroconvulsive therapy and double-cone-coil MST electric field was simulated in a 5-shell spherical human head model. A range of ECT electrode diameters (2-5 cm), spacing (1-25 cm), and current amplitudes (0-900 mA) was explored. The head model parameters were varied to examine the stimulus current adjustment required to compensate for interindividual anatomical differences.ResultsBy reducing the electrode size, spacing, and current, the ECT electric field can be more focal and superficial without increasing scalp current density. By appropriately adjusting the electrode configuration and current, the ECT electric field characteristics can be made to approximate those of MST within 15%. Most electric field characteristics in ECT are more sensitive to head anatomy variation than in MST, especially for close electrode spacing. Nevertheless, ECT current amplitude adjustment of less than 70% can compensate for interindividual anatomical variability.ConclusionsThe strength and focality of ECT can be varied over a wide range by adjusting the electrode size, spacing, and current. If desirable, ECT can be made as focal as MST while using simpler stimulation equipment. Current amplitude individualization can compensate for interindividual anatomical variability.