Department of Psychiatry, Trinity College Dublin, St. Patrick's University Hospital, Dublin, Ireland.
World J Biol Psychiatry. 2012 Apr;13(4):248-58. doi: 10.3109/15622975.2011.615863. Epub 2011 Nov 18.
Our aim was to perform a meta-analysis of randomized controlled trials comparing efficacy and side effects of bifrontal (BF) ECT to bitemporal (BT) or unilateral (RUL) ECT in depression.
We performed a systematic review of randomized controlled trials comparing BF ECT with RUL or BT ECT in depression. Eight trials (n=617) reported some cognitive outcome. Efficacy was measured by reduction in Hamilton Depression Rating Scale score. Cognitive outcomes were limited to Mini-Mental State Examination (MMSE) in seven studies, with two studies measuring each of: Complex-figure delayed recall, Trail-making tests and verbal learning.
Efficacy was equal between BF and BT ECT (Hedges's g=0.102, P=0.345, confidence interval (CI): -0.110, 0.313) and BF and RUL ECT (standardized mean difference=-0.12, P=0.365, CI: -0.378, 0.139). Post-treatment MMSE score decline was less for BF than BT ECT (g=0.89, CI: 0.054, 1.724) but not RUL ECT. RUL ECT impaired Complex figure recall more than BF ECT (g=0.76, CI :0.487, 1.035), but BF ECT impaired word recall more than RUL ECT (g=-1.45, CI: -2.75, -0.15).
Bifrontal ECT is not more effective than BT or RUL ECT but may have modest short-term benefits for specific memory domains. BF ECT has potential advantages, but given longer experience with BT and RUL, bifrontal ECT requires better characterization.
我们旨在对比较双额（BF）与双颞（BT）或单侧（RUL）电抽搐疗法（ECT）治疗抑郁症的疗效和副作用的随机对照试验进行荟萃分析。
我们对比较 BF-ECT 与 RUL 或 BT-ECT 治疗抑郁症的随机对照试验进行了系统评价。八项试验（n=617）报告了一些认知结果。疗效通过汉密尔顿抑郁评定量表（HDRS）评分的降低来衡量。认知结果仅限于七个研究中的简易精神状态检查（MMSE），其中两项研究分别测量了复杂图形延迟回忆、连线测验和词语学习。
BF 与 BT-ECT（Hedges's g=0.102，P=0.345，置信区间（CI）：-0.110，0.313）和 BF 与 RUL-ECT（标准化均数差=-0.12，P=0.365，CI：-0.378，0.139）之间的疗效相等。与 BT-ECT 相比，BF-ECT 治疗后的 MMSE 评分下降较少（g=0.89，CI：0.054，1.724），但与 RUL-ECT 相比则没有差异。与 BF-ECT 相比，RUL-ECT 对复杂图形回忆的损害更大（g=0.76，CI：0.487，1.035），而 BF-ECT 对词语回忆的损害大于 RUL-ECT（g=-1.45，CI：-2.75，-0.15）。
BF-ECT 并不比 BT 或 RUL-ECT 更有效，但可能对特定记忆领域有短期的优势。BF-ECT 具有潜在优势，但鉴于 BT 和 RUL 的经验更丰富，BF-ECT 需要更好的特征描述。
