ECT Electrode Placement: Bitemporal, Bifrontal and Right Unilateral

Where the stimulus electrodes go affects both how well ECT works and its side effects. Psychiatrists choose the placement for each patient.

Bitemporal (BT)

• Position: both electrodes about 2.5 cm above the midpoint of a line from the outer canthus to the tragus, one on each side.
• Strengths: highly effective and often fast-acting.
• Considerations: more cognitive side effects than unilateral placement.
• Common use: urgent or severe cases.

Right unilateral (RUL, d’Elia)

• Position: one electrode at the right temporal position and the other near the vertex, just to the right of midline.
• Strengths: fewer cognitive side effects.
• Considerations: needs a higher dose relative to seizure threshold, often with brief or ultra-brief pulses.

Bifrontal (BF)

• Position: about 5 cm above the outer canthus on both sides.
• Strengths: may balance effectiveness and cognitive effects.
• Use: an option in some centres.

Practical tips

• Clean the skin and apply enough conductive jelly.
• Make sure electrodes contact the skin well and check impedance.
• Avoid jelly bridging between electrodes.
• Keep the placement consistent through the course unless deliberately changed.

Equipment

Spring-loaded headbands and strap electrodes help secure placement. The MEDICA brief pulse ECT includes these, along with an LCD impedance check. Computerised ECT adds full monitoring.

Read about brief pulse dosing or contact us for training.