BACKGROUND Focal Electrically-Administered Seizure Therapy (FEAST) is a form of electroconvulsive therapy (ECT) that spatially focuses the electrical stimulus to initiate seizure activity in right prefrontal cortex. Two open-label non-comparative studies suggested that FEAST has reduced cognitive side effects when compared to historical data from other forms of ECT. In two different ECT clinics, we compared the efficacy and cognitive side effects of FEAST and Right Unilateral Ultrabrief Pulse (RUL-UBP) ECT. METHODS Using a non-randomized, open-label design, 39 depressed adults were recruited after referral for ECT. Twenty patients received FEAST (14 women; age 45.2±12.7), and 19 received RUL-UBP ECT (16 women; age 43.2±16.4). Key cognitive outcome measures were the postictal time to reorientation and the Columbia University Autobiographical Memory Interview: Short-Form (CUAMI-SF). Antidepressant effects were assessed using the Hamilton Rating Scale for Depression (HRSD24). RESULTS In the Intent-to-treat sample, a repeated measures mixed model suggested no between group difference in HRSD24 score over time (F1,35 = 0.82, p=0.37), while the response rate favored FEAST (FEAST: 65%; RUL-UBP ECT: 57.9%), and the remission rate favored RUL-UBP ECT (FEAST: 35%; RUL-UBP ECT: 47.4%). The FEAST group had numeric superiority in average time to reorientation (FEAST: 6.6±5.0 minutes; RUL-UBP ECT: 8.8±5.8 minutes; Cohens d = 0.41), and CUAMI-SF consistency score (FEAST: 69.2±14.2%; RUL-UBP ECT: 63.9±9.9%; Cohens d = 0.43); findings that failed to meet statistical significance. CONCLUSIONS FEAST exerts similar efficacy relative to an optimal form of conventional ECT and may have milder cognitive side effects. A blinded, randomized, non-inferiority trial is needed.

中文翻译：

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比较局部电癫痫发作治疗 (FEAST) 和右侧单侧超短脉冲电惊厥治疗 (RUL-UBP ECT) 的两部位、开放标签、非随机试验

背景技术局灶性癫痫电治疗（FEAST）是电惊厥治疗（ECT）的一种形式，其在空间上集中电刺激以引发右前额皮质的癫痫活动。两项开放标签非比较研究表明，与其他形式 ECT 的历史数据相比，FEAST 减少了认知副作用。在两个不同的 ECT 诊所中，我们比较了 FEAST 和右单侧超短脉冲 (RUL-UBP) ECT 的疗效和认知副作用。方法 采用非随机、开放标签设计，招募了 39 名转诊接受 ECT 的抑郁症成年人。20 名患者接受 FEAST（14 名女性；年龄 45.2±12.7），19 名患者接受 RUL-UBP ECT（16 名女性；年龄 43.2±16.4）。关键的认知结果测量是发作后重新定向时间和哥伦比亚大学自传体记忆访谈：简短形式（CUAMI-SF）。使用汉密尔顿抑郁量表（HRSD24）评估抗抑郁效果。结果在意向治疗样本中，重复测量混合模型表明随着时间的推移，HRSD24 评分组间没有差异（F1,35 = 0.82，p = 0.37），而反应率有利于 FEAST（FEAST：65％；RUL） -UBP ECT：57.9%），缓解率优于RUL-UBP ECT（FEAST：35%；RUL-UBP ECT：47.4%）。FEAST 组在平均重新定向时间（FEAST：6.6±5.0 分钟；RUL-UBP ECT：8.8±5.8 分钟；Cohens d = 0.41）和 CUAMI-SF 一致性评分（FEAST：69.2±14.2%；RUL）方面具有数字优势。 -UBP ECT：63.9±9.9%；Cohens d = 0.43)；结果未能达到统计学显着性。结论 FEAST 与传统 ECT 的最佳形式相比具有相似的功效，并且可能具有较轻微的认知副作用。需要进行盲法、随机、非劣效性试验。