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Limited focality represents a technical limitation of conventional ECT, and there is growing evidence that the spatial distribution of the ECT electric fields induced in the brain drives efficacy and side effects. Computational models can be used to predict brain current flow patterns for existing and novel ECT montages. Using finite element method simulations (under quasi-static, nonadaptive assumptions, 800-mA total current), the electric fields generated in the superficial cortex and subcortical structures were predicted for the following traditional ECT montages (bilateral temporal, bifrontal, right unilateral) and experimental montages (focal electrically administered seizure therapy, lateralized high-definition [HD]-ECT, unilateral 4\u2009\u00d7\u20091-ring HD-ECT, bilateral 4\u2009\u00d7\u20091-ring HD-ECT, and a multipolar HD-ECT). Peak brain current density in regions of interest was quantified. Conventional montages (bilateral bifrontal, right unilateral) each produce distinct but diffuse and deep current flow. Focal electrically administered seizure therapy and lateralized HD-ECT produce unique, lateralized current flow, also impacting specific deep regions. A 4\u2009\u00d7\u20091-ring HD-ECT restricts current flow to 1 (unilateral) or 2 (bilateral) cortical regions. Multipolar HD-ECT shows optimization to a specific target set. Future clinical trials are needed to determine whether enhanced control over current distribution is achieved with these experimental montages, and the resultant seizures, improve the risk\/benefit ratio of ECT.<\/jats:p>","DOI":"10.1097\/yct.0000000000001069","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T09:37:49Z","timestamp":1724665069000},"page":"223-231","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Computational Models of High-Definition Electroconvulsive Therapy for Focal or Multitargeting Treatment"],"prefix":"10.1097","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4930-5214","authenticated-orcid":false,"given":"Niranjan","family":"Khadka","sequence":"first","affiliation":[{"name":"Division of Neuropsychiatry and Neuromodulation, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-De","family":"Deng","sequence":"additional","affiliation":[{"name":"Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah H.","family":"Lisanby","sequence":"additional","affiliation":[{"name":"Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marom","family":"Bikson","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, The City College of New York, CUNY, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joan A.","family":"Camprodon","sequence":"additional","affiliation":[{"name":"Division of Neuropsychiatry and Neuromodulation, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,8,26]]},"reference":[{"key":"bib1-20251124","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.psc.2018.04.001","article-title":"Electroconvulsive therapy in depression: current practice and future direction","volume":"41","author":"Hermida","year":"2018","journal-title":"Psychiatr Clin North Am"},{"key":"bib2-20251124","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1176\/appi.ajp.159.2.331","article-title":"The practice of electroconvulsive therapy: recommendations for treatment, training, and privileging: a task force report of the American Psychiatric Association, 2nd ed","volume":"159","author":"Jaffe","year":"2002","journal-title":"AJP"},{"key":"bib3-20251124","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1097\/00124509-200403000-00004","article-title":"Efficacy of ECT in depression: a meta-analytic review","volume":"20","author":"Pagnin","year":"2004","journal-title":"J ECT"},{"key":"bib4-20251124","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.brs.2008.03.001","article-title":"Effects of pulse width and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy","volume":"1","author":"Sackeim","year":"2008","journal-title":"Brain Stimul"},{"key":"bib5-20251124","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1001\/archpsyc.57.5.425","article-title":"A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities","volume":"57","author":"Sackeim","year":"2000","journal-title":"Arch Gen Psychiatry"},{"key":"bib6-20251124","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1056\/NEJM199303253281204","article-title":"Effects of stimulus intensity and electrode placement on the efficacy and cognitive effects of electroconvulsive therapy","volume":"328","author":"Sackeim","year":"1993","journal-title":"N Engl J Med"},{"key":"bib7-20251124","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1016\/j.brs.2021.09.014","article-title":"Effects of modifying the electrode placement and pulse width on cognitive side effects with unilateral ECT: a pilot randomised controlled study with computational modelling","volume":"14","author":"Martin","year":"2021","journal-title":"Brain Stimul"},{"key":"bib8-20251124","first-page":"93","article-title":"Physical properties and quantification of the ECT stimulus: I. 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