Biophysical mechanisms of electroconvulsive therapy-induced volume expansion in the medial temporal lobe: A longitudinal in vivo human imaging study,Brain Stimulation

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Biophysical mechanisms of electroconvulsive therapy-induced volume expansion in the medial temporal lobe: A longitudinal in vivo human imaging study
Brain Stimulation ( IF 7.7 ) Pub Date : 2021-06-25 , DOI: 10.1016/j.brs.2021.06.011
Akihiro Takamiya ₁ , Filip Bouckaert ₂ , Maarten Laroy ₃ , Jeroen Blommaert ₄ , Ahmed Radwan ₅ , Ahmad Khatoun ₆ , Zhi-De Deng ₇ , Myles Mc Laughlin ₆ , Wim Van Paesschen ₈ , François-Laurent De Winter ₂ , Jan Van den Stock ₂ , Stefan Sunaert ₉ , Pascal Sienaert ₁₀ , Mathieu Vandenbulcke ₂ , Louise Emsell ₁₁

Affiliation

KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium.
KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium.
KU Leuven, Department of Oncology, Gynaecological Oncology, Leuven, Belgium.
KU Leuven, Department of Imaging & Pathology, Translational MRI, Leuven, Belgium.
KU Leuven, Leuven Brain Institute, Department of Neurosciences, Research Group Experimental Oto-rhino-laryngology, Leuven, Belgium.
Noninvasive Neuromodulation Unit, Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.
KU Leuven, Leuven Brain Institute, Department of Neurosciences, Research Group Experimental Neurology, Leuven, Belgium.
KU Leuven, Department of Imaging & Pathology, Translational MRI, Leuven, Belgium; Department of Radiology, University Hospitals Leuven (UZ Leuven), Leuven, Belgium.
Academic Center for ECT and Neuromodulation (AcCENT), University Psychiatric Center, KU Leuven, Kortenberg, Belgium.
KU Leuven, Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium; Geriatric Psychiatry, University Psychiatric Center KU Leuven, Belgium; KU Leuven, Department of Imaging & Pathology, Translational MRI, Leuven, Belgium.

Background

Electroconvulsive therapy (ECT) applies electric currents to the brain to induce seizures for therapeutic purposes. ECT increases gray matter (GM) volume, predominantly in the medial temporal lobe (MTL). The contribution of induced seizures to this volume change remains unclear.

Methods

T1-weighted structural MRI was acquired from thirty patients with late-life depression (mean age 72.5 ± 7.9 years, 19 female), before and one week after one course of right unilateral ECT. Whole brain voxel-/deformation-/surface-based morphometry analyses were conducted to identify tissue-specific (GM, white matter: WM), and cerebrospinal fluid (CSF) and cerebral morphometry changes following ECT. Whole-brain voxel-wise electric field (EF) strength was estimated to investigate the association of EF distribution and regional brain volume change. The association between percentage volume change in the right MTL and ECT-related parameters (seizure duration, EF, and number of ECT sessions) was investigated using multiple regression.

Results

ECT induced widespread GM volume expansion with corresponding contraction in adjacent CSF compartments, and limited WM change. The regional EF was strongly correlated with the distance from the electrodes, but not with regional volume change. The largest volume expansion was identified in the right MTL, and this was correlated with the total seizure duration.

Conclusions

Right unilateral ECT induces widespread, bilateral regional volume expansion and contraction, with the largest change in the right MTL. This dynamic volume change cannot be explained by the effect of electrical stimulation alone and is related to the cumulative effect of ECT-induced seizures.

中文翻译：

电惊厥治疗引起内侧颞叶体积膨胀的生物物理机制：纵向体内人体成像研究

背景

电惊厥疗法 (ECT) 将电流施加到大脑以诱导癫痫发作以达到治疗目的。ECT 增加灰质 (GM) 体积，主要在内侧颞叶 (MTL)。诱发癫痫发作对这种体积变化的贡献尚不清楚。

方法

T1 加权结构 MRI 从 30 名晚年抑郁症患者（平均年龄 72.5 ± 7.9 岁，19 名女性）在右侧单侧 ECT 一个疗程之前和之后一周获得。进行了基于全脑体素/变形/表面的形态测量分析，以识别组织特异性（GM，白质：WM）和脑脊液 (CSF) 以及 ECT 后的脑形态测量变化。估计全脑体素电场 (EF) 强度以研究 EF 分布与区域脑容量变化的关联。使用多元回归研究了右侧 MTL 的体积变化百分比与 ECT 相关参数（癫痫发作持续时间、EF 和 ECT 次数）之间的关联。