Comparison of electric field strength and spatial distribution of electroconvulsive therapy and magnetic seizure therapy in a realistic human head model.
Comparison of electric field strength and spatial distribution of electroconvulsive therapy and magnetic seizure therapy in a realistic human head model.
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DOI：
10.1016/j.eurpsy.2016.03.003
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发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
Peterchev AV
中科院分区：
文献类型：
--
作者：
Lee WH;Lisanby SH;Laine AF;Peterchev AV
本研究探讨了电惊厥疗法(ECT)和磁惊厥疗法(MST)在脑内诱发电场的强度和空间分布。在人体头部的解剖模型中，模拟了标准(双侧、右侧和双侧)和实验(局灶性癫痫治疗和额内侧)ECT电极配置以及圆形MST线圈配置所产生的电场。使用相对于估计的神经激活阈值的电场强度图来评估这些ECT和MST范例以及不同刺激电流幅度在特定大脑感兴趣区的刺激强度和焦点。标准的ECT配置和电流幅度800~900 mA产生的整体刺激最强，中位数为神经激活阈值的1.8~2.9倍，阈值上刺激的脑体积的94%以上。所有标准的ECT电极放置都将海马区暴露在阈值上的电场中，尽管不同的模式存在差异，双侧和右侧分别产生最强和最弱的海马区刺激。MST刺激比传统的ECT弱9倍，导致只有21%的大脑直接激活。降低刺激电流幅度可以使ECT像MST一样聚焦。电场强度的相对差异可能是右侧ECT与双侧ECT相比、MST与右侧ECT相比出现认知保留的原因之一。这些模拟可以帮助理解癫痫治疗的机制，并开发具有更高风险/收益比的干预措施。
This study examines the strength and spatial distribution of the electric field induced in the brain by electroconvulsive therapy (ECT) and magnetic seizure therapy (MST). The electric field induced by standard (bilateral, right unilateral, and bifrontal) and experimental (focal electrically administered seizure therapy and frontomedial) ECT electrode configurations as well as a circular MST coil configuration was simulated in an anatomically realistic finite element model of the human head. Maps of the electric field strength relative to an estimated neural activation threshold were used to evaluate the stimulation strength and focality in specific brain regions of interest for these ECT and MST paradigms and various stimulus current amplitudes. The standard ECT configurations and current amplitude of 800–900 mA produced the strongest overall stimulation with median of 1.8–2.9 times neural activation threshold and more than 94% of the brain volume stimulated at suprathreshold level. All standard ECT electrode placements exposed the hippocampi to suprathreshold electric field, although there were differences across modalities with bilateral and right unilateral producing respectively the strongest and weakest hippocampal stimulation. MST stimulation is up to 9 times weaker compared to conventional ECT, resulting in direct activation of only 21% of the brain. Reducing the stimulus current amplitude can make ECT as focal as MST. The relative differences in electric field strength may be a contributing factor for the cognitive sparing observed with right unilateral compared to bilateral ECT, and MST compared to right unilateral ECT. These simulations could help understand the mechanisms of seizure therapies and develop interventions with superior risk/benefit ratio.