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The frontal placement sounds interesting - but more interesting is my
groing feeling that there is no standardisation in the way that
ECT is being given. We used to think that it was a UK problem, but that has largely been improved by college initiatives - ok mostly we only do bilateral, but at least twice a week is a standard. Energy settings and electrode types are pretty standard now, and of course basic training is standardised too. At an ECT training meeting (which presumably 'selected' clinicians that were at least interested in doing a good job) I met people restimulating on the basis of single channel EEG waveforms, people who didnt know what the 'seizure detection' line on the Thymatron meant, people that could not EVER get a sieizure with anything less than 100% energy settings on the same machine. And that is before we started to talk about indications for ECT and evaluating outcome or side effects. This list gives me a similar feeling sometimes. Im not about to say anyone is wrong (or even that I'm right) but the sheer spread of practice across the world is most unsettling.
Carl Littlejohns |