الفهرس 
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Abstract
Electroconvulsive therapy is a standard psychiatric treatment in which seizures are electrically induced in patients to provide relief from psychiatric illnesses.
ECT is generally administered in a specially designated area where there is adequate physical space for pre- and post-treatment observation, full range of equipment for the provision of anesthesia as well as emergency and resuscitation equipment. Usually ECT considered as a safe procedure with a mortality rate currently estimated at about less than 1 death per 73,440 treatments. This is equivalent to the mortality rate attributed to anesthesia for ambulatory surgery and is below that reported for normal childbirth
The clinical efficacy of ECT depends on the induction of generalized cerebral seizure activity, However its mode of action is not clearly understood. There is evidence that ECT alters the function and the structure of important brain areas, especially the front temporal circuits involved in mood Neurogenesis. Also alterations in synaptic plasticity, increased hippocampal choline concentrations, normalization of HPA axis dysfunction and increasing of blood flow in the basal ganglia, brainstem, and diencephalon, have been proposed as a common mechanism in Electroconvulsive therapy.
Electroconvulsive therapy is a proven effective treatment for depression especially those with high suicidal risk, severe psychomotor retardation physical deterioration and treatment-resistant depression. It is a safe form of treatment even in the medically ill, the elderly and in pregnancy. ECT is an effective treatment for acute mania. Recent reports suggest that ECT should be considered in mania cases that are acutely treatment refractory, delirious mania or in rapid-cycling manic states .ECT is recommended also in schizophrenic patients especially those with a history of a favorable response to ECT, abrupt psychotic exacerbations, catatonic schizophrenia, or schizoaffective disorder
Cognitive adverse effect is arguably the single most important concern regarding ECT. Cognitive side effects from ECT can be separated into four different types: acute-onset delirium, gradual cumulative disorientation, anterograde amnesia and retrograde memory loss. Although memory is altered in the period immediately following ECT, permanent memory loss is uncommon, even after numerous ECT sessions
The degree of memory impairment depends on several factors. The number of ECT sessions, the width of the electrical pulse, stimulus dosage and the lateralization of the electrodes greatly affect the degree of post ECT cognitive impairment.
In most studies right unilateral electroconvulsive therapy (ECT) has been shown to cause fewer cognitive side effects but less efficacy compared with bi(fronto)temporal ECT at certain intensities. Differences in cognitive outcome between bitemporal and bifrontal electrode placement documented by controlled studies vary from minor to nonexistent. Even some of these few differences can be attributed to differing stimulus doses. The absence of proof of differing outcomes does not prove that there are no differences.
This study is comparative cross sectional study between BF-ECT and BT-ECT regarding cognitive side effects.
Study population Consist of 2 groups:
group A: taken from patients referred to the ECT unit, the patients in this group has 8 session of BF-ECT ,and cognitive assessment using MoCA test before ECT and after each even session then monthly after the end of ECT course for 6 months
group B: taken from patients referred to the ECT unit, the patients in this group has 8 session of BT-ECT ,and cognitive assessment using MoCA test before ECT and after each even session then monthly after the end of ECT course for 6 months.
Sample size:
group A (BF-ECT): formed of 19 patients, as the sample was supposed to be formed of at least 24 patients, but 5 patients refused to complete the study.
group B (BT-ECT): formed of 21 patients, as the sample was supposed to be formed of 24 patients, but 3 patients refused to complete the study.
Demographic descriptive statistics of the sample shows no statistically significant difference between the 2 groups for age or sex .Also clinical diagnosis was comparable in both groups in order to negate its possible impact and possible side effects of antipsychotic drugs on cognitive functions.
Our study shows statistically significant difference between the two groups as regard cognitive functions beginning after the second session until the 3nd month after the last session, with the bifrontal group having better cognitive functions. Although there is no statistically significant difference between both groups regarding visuospacial abilities ,abstraction and orientation . Our study shows better score for the BF-ECT group from the 2nd session till the end of ECT course regarding language and executive functions , while BF-ECT shows advantage over the BT-ECT regarding attention abilities and memory assessment from the 2nd session till the 2nd and 3rd month respectively.
As for the follow up assessment for the cognitive functions, BF-ECT group shows no statistically significant difference between baseline cognitive assessment and the cognitive assessment starting from the first month after the end of ECT, however BT-ECT group shows no statistically significant difference between baseline cognitive assessment and the cognitive assessment starting from fourth month after the end of ECT.
As for the patients diagnosed with schizophrenia, the study shows significant statistical difference between the bitemporal and bifrontal ECT regarding the cognitive functions with the bifrontal group having better cognitive outcome.