Bifrontal ECT: A Systematic Review and Meta-Analysis of Efficacy and Cognitive Impact

The aim of this paper is to review the literature regarding bifrontal electroconvulsive therapy (ECT) and provide recommendations for future research in this area. Original publications were retrieved using PubMeD, EMBASE, PsycINFO, and Google Scholar. A systematic review and meta-analysis of randomised clinical trials examining efficacy and/or cognitive effects of bifrontal ECT for the treatment of depression is the centrepiece of this paper. The literature regarding bifrontal ECT is limited, with small patient numbers and treatment variation across studies complicating result interpretation. However, our findings suggest that while bifrontal and bitemporal ECT may have similar efficacy, bifrontal ECT is associated with less cognitive impairment immediately after a treatment course. Bifrontal ECT may have greater efficacy than low-dose right unilateral ECT but less efficacy than high-dose right unilateral ECT. Conversely, bifrontal ECT may affect cognition more adversely than low-dose right unilateral ECT, but less so than high-dose right unilateral ECT. To further investigate the likely favourable benefit to cognitive risk profile of bifrontal ECT, detailed cognitive testing should be undertaken as part of any future, large scale studies comparing the efficacy of adequately-dosed bifrontal, bitemporal and right unilateral ECT.