But more recent studies have questioned the equivalence of RUL and BT. It was thought that any stimulus sufficient to elicit a grand mal seizure would be clinically effective, regardless of electrode placement. While that concept is true for BT, the efficacy of RUL depends on the level of energy above a measured seizure threshold. Indeed, effective RUL required six times the seizure threshold to approximate the efficacy of BT (3). Unfortunately, increasing the energy level increases immediate cognitive deficits, vitiating any vaunted advantage for RUL (4).