Modem electroconvulsive therapy (ECT) involves the administration of six to ten convulsions of sufficient duration (25 seconds) by unilateral electrical stimulation of the non-dominant hemisphere. Missed or abortive seizures are a common clinical problem but may often be accounted for by concurrent medication and technical problems with unilateral ECT seizure induction. In the absence of such factors, controlled hyperventilation and intravenous caffeine are adjunctive means to achieve an adequate unilateral ECT treatment course.