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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 (HRSD 24 )., Results: In the Intent-to-treat sample, a repeated measures mixed model suggested no between group difference in HRSD 24 score over time (F 1,35  = 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 min; RUL-UBP ECT: 8.8 ± 5.8 min; 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., Competing Interests: Declaration of competing interest This study was supported in part by an unrestricted educational grant from the MECTA Corporation. The MECTA Corporation also provided custom-modified MECTA spECTrum 5000Q devices. Dr. Sackeim is the inventor on a patent for FEAST (US8712532 B2) and serves as a consultant to the MECTA Corporation, Neuronetics Inc, and LivaNova LPC. Dr. McCall receives research support from MECTA, Vistagen, and Merck. Dr. McCall receives royalties from Wolters Kluwer, and is a scientific adviser for Jazz, Sage, and Janssen Pharmaceuticals. None of the other authors have any conflicts. Dr. Youssef discloses that he receives research support (but not salary support) from the U.S. Department of Veterans Affairs, Augusta Biomedical Research Corporation, Merck & Co., VistaGen Therapeutics, Inc., and MECTA Corporation., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Electroconvulsive therapy (ECT) has demonstrated efficacy in treating core symptoms of Parkinson's disease (PD); however, widespread use of ECT in PD has been limited due to concern over cognitive burden. We investigated the use of a newer ECT technology known to have fewer cognitive side effects (right unilateral [RUL] ultra-brief pulse [UBP]) for the treatment of medically refractory psychiatric dysfunction in PD., Materials and Methods: This open-label pilot study included 6 patients who were assessed in the motoric, cognitive, and neuropsychiatric domains prior to and after RUL UBP ECT. Primary endpoints were changes in total score on the HAM-D-17 and GDS-30 rating scales., Results: Patients were found to improve in motoric and psychiatric domains following RUL UBP ECT without cognitive side effects, both immediately following ECT and at 1-month follow-up., Conclusions: This study demonstrates that RUL UBP ECT is safe, feasible, and potentially efficacious in treating multiple domains of PD, including motor and mood, without clear cognitive side effects., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: Electroconvulsive therapy (ECT) is the most rapid and effective antidepressant treatment but with concerns about cognitive adverse effects. A new form of ECT, focal electrically administered seizure therapy (FEAST), was designed to increase the focality of stimulation and better match stimulus parameters with neurophysiology. We recently reported on the safety and feasibility of FEAST in a cohort (n = 17) of depressed patients. We now report on the safety, feasibility, preliminary efficacy, and cognitive effects of FEAST in a new cohort., Methods: Open-label FEAST was administered to 20 depressed adults (6 men; 3 with bipolar disorder; age 49.1 ± 10.6 years). Clinical and cognitive assessments were obtained at baseline and end of course. Time to orientation recovery was assessed at each treatment. Nonresponders switched to conventional ECT., Results: Participants tolerated the treatment well with no dropouts. Five patients (25%) transitioned from FEAST to conventional ECT due to inadequate response. After FEAST (mean, 9.3 ± 3.5 sessions; range, 4-14), there was a 58.1% ± 36.0% improvement in Hamilton Rating Scale for Depression scores compared with that in the baseline (P < 0.0001); 13 (65%) of 20 patients met response criteria, and 11 (55%) of 20 met remission criteria. Patients achieved reorientation (4 of 5 items) in 4.4 ± 3.0 minutes (median, 4.5 minutes), timed from eyes opening. There was no deterioration in neuropsychological measures., Conclusions: These findings provide further support for the safety and efficacy of FEAST. The remission and response rates were in the range found using conventional ECT, and the time to reorientation may be quicker. However, without a randomized comparison group, conclusions are tentative., Competing Interests: This study was supported in part by an unrestricted educational grant from the MECTA Corporation. The MECTA Corporation also provided a custom-modified MECTA spECTrum 5000Q device. Dr Sackeim is the inventor on a patent for FEAST (US8712532 B2) and serves as a consultant to the MECTA Corporation and Neuronetics, Inc. All other authors have no conflicts of interest or financial disclosures to report.

Purpose of Review: There has been a resurgence of interest in brain stimulation techniques as therapies for psychiatric disorders. Various names are used for this class of treatments: neuromodulation, somatic therapies, brain stimulation techniques. The methods in this class range from non-invasive (transcranial magnetic stimulation) to invasive brain surgery (deep brain stimulation)., Recent Findings: Within the past year, the results of several large multicenter trials have been published, clearing the way for US Food and Drug Administration approval of vagus nerve stimulation for recurrent treatment-resistant depression and a pending consideration of approving transcranial magnetic stimulation for the treatment of depression., Summary: This article reviews the most important recent clinically relevant manuscripts in this rapidly expanding new field.