Subgenual cingulate cortical activity predicts the efficacy of electroconvulsive therapy.
Subgenual cingulate cortical activity predicts the efficacy of electroconvulsive therapy.
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DOI：
10.1038/tp.2016.54
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发表时间：
2016-04-26
影响因子：
6.8
通讯作者：
Petrides G
中科院分区：
文献类型：
--
作者：
Argyelan M;Lencz T;Kaliora S;Sarpal DK;Weissman N;Kingsley PB;Malhotra AK;Petrides G
电休克疗法（ECT）是治疗抑郁症最有效的方法，但其作用机制尚不清楚。我们的目标是研究ECT反应的神经生物学基础，使用纵向收集静息态功能磁共振成像（rs-fMRI）在16例难治性抑郁症患者和10名健康对照。患者在全身麻醉下接受每周3次的双额叶ECT。我们在三个时间点获得了rs-fMRI：基线时，第一次ECT给药后和ECT治疗过程后;抑郁与汉密尔顿抑郁量表（HAM-D）进行了评估。来自rs-fMRI的主要措施是低频波动的分数振幅（fALFF），它提供了一个无偏的体素的大脑活动的估计。我们还根据我们的主要发现进行了基于种子的功能连接分析。我们比较了治疗前和治疗后的fALFF和连接措施的HAM-D评分的治疗相关变化。在抑郁症患者中，胼胝体下扣带皮层（SCC）在基线时表现出较高的BOLD信号波动（fALFF），并且SCC fALFF在治疗过程中降低。SCC的fALFF基线水平预测ECT的反应。此外，在治疗过程中，SCC与双侧海马、双侧颞极和腹内侧前额叶皮质的连接性显著降低。这些结果表明，ECT的抗抑郁作用可能是通过下调SCC的活性和连接介导的。SCC功能可以作为一个重要的生物标志物的目标参与开发新的治疗抑郁症是耐药的标准药物治疗。
Electroconvulsive therapy (ECT) is the most effective treatment for depression, yet its mechanism of action is unknown. Our goal was to investigate the neurobiological underpinnings of ECT response using longitudinally collected resting-state functional magnetic resonance imaging (rs-fMRI) in 16 patients with treatment-resistant depression and 10 healthy controls. Patients received bifrontal ECT 3 times a week under general anesthesia. We acquired rs-fMRI at three time points: at baseline, after the 1st ECT administration and after the course of the ECT treatment; depression was assessed with the Hamilton Depression Rating Scale (HAM-D). The primary measure derived from rs-fMRI was fractional amplitude of low frequency fluctuation (fALFF), which provides an unbiased voxel-wise estimation of brain activity. We also conducted seed-based functional connectivity analysis based on our primary findings. We compared treatment-related changes in HAM-D scores with pre- and post-treatment fALFF and connectivity measures. Subcallosal cingulate cortex (SCC) demonstrated higher BOLD signal fluctuations (fALFF) at baseline in depressed patients, and SCC fALFF decreased over the course of treatment. The baseline level of fALFF of SCC predicted response to ECT. In addition, connectivity of SCC with bilateral hippocampus, bilateral temporal pole, and ventromedial prefrontal cortex was significantly reduced over the course of treatment. These results suggest that the antidepressant effect of ECT may be mediated by downregulation of SCC activity and connectivity. SCC function may serve as an important biomarker of target engagement in the development of novel therapies for depression that is resistant to treatment with standard medications.