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To the Editor: In their Commentary regarding the value of electroconvulsive therapy (ECT), Drs Fink and Taylor¹ did not address an important consideration in its use. They state that the effect of ECT on memory is "circumscribed and mostly transient" and that there is only a "modest cognitive advantage of high-dose unilateral ECT."

However, some forms of ECT are associated with an increased risk of persistent long-term effects on cognitive performance in community settings. In a cohort study, bilateral ECT was associated with broader and more severe short-term and long-term cognitive effects than right unilateral ECT; adverse cognitive effects could persist for an extended period, and "only receipt of bilateral treatment distinguished the group with marked and persistent retrograde amnesia."² In addition, a small study found that during the interictal stage of bilateral ECT, enhanced left frontotemporal theta activity was correlated with retrograde amnesia,³ suggesting that left medial temporal lobe structures are involved in the pathophysiology of ECT-induced memory effects.

Financial Disclosure: Ms Donahue reported that she brought a malpractice suit alleging that unnecessary use and extent of bilateral ECT to achieve remission of her major depression in 1995 and 1996 resulted in significant retrograde amnesia. The lawsuit was settled out of court in 2000 with standards of practice agreed to by the defendant hospital and no direct financial remuneration to the plaintiff. Confidentiality regarding details of the settlement was required by the defendant.

AUTHOR INFORMATION
This letter was shown to Dr Fink, who declined to reply on behalf of the authors. —ED.

Anne B. Donahue, JD
counterp{at}tds.net
Vermont State House
Montpelier

1. Fink M, Taylor MA. Electroconvulsive therapy: evidence and challenges. JAMA. 2007;298(3):330-332. FREE FULL TEXT 2. Sackeim HA, Prudic J, Fuller R, Keilp J, Lavori PW, Olfson M. The cognitive effects of electroconvulsive therapy in community settings. Neuropsychopharmacology. 2007;32(1):244-254. FULL TEXT | ISI | PUBMED 3. Neuhaus AH, Gallinat J, Bajbouj M, Reischies FM. Interictal slow-wave focus in left medial temporal lobe during bilateral electroconvulsive therapy. Neuropsychobiology. 2005;52(4):183-189. FULL TEXT | ISI | PUBMED

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298:1862.

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Electroconvulsive Therapy: Evidence and Challenges
Max Fink and Michael Alan Taylor
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