  Modified-Electroconvulsive Therapy (m-ECT) is administered for the treatment
of various psychiatric disorders. The Seizure Generalization Hypothesis holds
that propagation of the induced seizure throughout the whole brain is essential
for the effective ECT intervention. However, we encounter many clinical cases
where, due to high thresholds, seizure is not induced by the maximum dose of
electrical charge. Some studies have indicated that the ultrabrief pulse
method, in which pulse width is less than 0.5millisecond (ms), is more
effective at inducing seizure than conventional brief pulse (0.5ms-2.0ms).
Contrary to the studies, we experienced a case of schizophrenia in which m-ECT
with 1.0 and 1.5 ms width pulse (referred to as 'long' brief pulse as 0.5ms
width pulse is the default in Japan) succeeded in inducing seizure, whereas
ultrabrief pulse failed to induce seizure. This case is described in detail.
Moreover, we discuss the underlying mechanism of this phenomenon.
