Low amplitude pulse seizure therapy (LAP-ST): a form of seizure therapy with potential for reduced cognitive and memory side effects - a narrative review
Abstract
Introduction: Low Amplitude Seizure Therapy (LAP-ST) is a modification of electroconvulsive therapy (ECT) in which current amplitude is reduced below the 800-900 mA used by contemporary current-constant devices. Preliminary studies have investigated whether this approach can retain therapeutic effects while reducing cognitive adverse effects.
Areas covered: The authors review the historical origins of low-amplitude convulsive stimulation, the electric-field rationale for amplitude reduction, and clinical evidence for LAP-ST. We searched PubMed, MEDLINE, EMBASE and PsycINFO (inception to May 2026) and hand-searched historical sources and reference lists. The authors give review to an identified pilot case series, two open-label studies (feasibility; proof-of-concept), two double-blind randomized trials (one a pilot reported across three publications) and a prospective amplitude-titration trial, alongside finite-element modeling studies, which are included herein.
Expert opinion: Low pulse amplitude was used to elicit therapeutic seizures decades before fixed-current devices became standard. Pilot LAP-ST trials found no clear differences in antidepressant or anti-suicidal outcomes versus standard right-unilateral ultra-brief ECT and report shorter post-ictal reorientation times. Reorientation time is the strongest predictor of retrograde autobiographical memory change after ECT, though not direct evidence of preserved memory. Larger, adequately powered randomized trials are…
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