Structural changes in amygdala nuclei, hippocampal subfields and cortical thickness following electroconvulsive therapy in treatment-resistant depression: longitudinal analysis
Structural changes in amygdala nuclei, hippocampal subfields and cortical thickness following electroconvulsive therapy in treatment-resistant depression: longitudinal analysis
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DOI：
10.1192/bjp.2018.224
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发表时间：
2019-03-01
影响因子：
10.5
通讯作者：
Lanzenberger, Rupert
中科院分区：
文献类型：
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作者：
Gryglewski, Gregor;Baldinger-Melich, Pia;Lanzenberger, Rupert
背景电休克治疗(ECT)是包括难治性抑郁症(TRD)在内的严重精神疾病的首选治疗方法。ECT后海马体和杏仁核体积的增加一直有报道。旨在使用高分辨率结构磁共振成像(MRI)研究ECT后特定海马区和杏仁核的神经可塑性变化(试验注册：ClinicalTrials.gov-NCT02379767)。方法对14例患者(女性11例，年龄46.9岁)进行MRI扫描。=8.1))，在一系列右侧单侧ECT治疗前和治疗后分别进行两次单极TRD和一次TRD。使用Freesurfer提取皮质下结构的体积，包括海马区和杏仁体的子区，以及皮质厚度。采用重复测量方差分析方法检验ECT的疗效。探讨影像参数与临床参数的相关性。结果右侧海马区体积增加139.4 mm(3)(S.D.=34.9)，右侧杏仁核长82.3 mm(3)(S.D.=43.9)，右侧壳核下移73.9 mm(3)(S.D.=77.0)。这些改变定位于基底核和外侧核，杏仁核的皮质杏仁核过渡区，海马-杏仁核过渡区以及齿状回的颗粒细胞和分子层。右侧大脑半球的颞叶、顶叶和岛叶皮质增厚。结论电击治疗后，海马亚区和杏仁核结构发生改变，与抑郁症和应激相关疾病的病理生理学有关，成年后仍具有较高的神经可塑性。利益声明S.K.在过去3年内从Angelini公司、AOP孤儿制药公司、阿斯利康公司、塞莱恩公司、礼来公司、扬森-齐拉格制药有限公司、Krka-Pharma公司、Lundbeck A/S公司、Neuraxpharm公司、辉瑞公司、Pierre Fabre公司、施瓦布公司和Servier公司获得了赠款/研究支持、咨询费和/或酬金。R.L.从Shire、AstraZeneca、Lundbeck A/S、Dr.Willmar Schwabe GmbH、Orphan PharmPharmticals AG、Janssen-Cilag Pharma GmbH和罗氏奥地利有限公司获得了差旅补助和/或会议演讲者酬金。
Background Electroconvulsive therapy (ECT) is the treatment of choice for severe mental illness including treatment-resistant depression (TRD). Increases in volume of the hippocampus and amygdala following ECT have consistently been reported. Aims To investigate neuroplastic changes after ECT in specific hippocampal subfields and amygdala nuclei using high-resolution structural magnetic resonance imaging (MRI) (trial registration: clinicaltrials.gov - NCT02379767). Method MRI scans were carried out in 14 patients (11 women, 46.9 years (s.d. = 8.1)) with unipolar TRD twice before and once after a series of right unilateral ECT in a pre-post study design. Volumes of subcortical structures, including subfields of the hippocampus and amygdala, and cortical thickness were extracted using FreeSurfer. The effect of ECT was tested using repeated-measures ANOVA. Correlations of imaging and clinical parameters were explored. Results Increases in volume of the right hippocampus by 139.4 mm(3) (s.d. = 34.9), right amygdala by 82.3 mm(3) (s.d. = 43.9) and right putamen by 73.9 mm(3) (s.d. = 77.0) were observed. These changes were localised in the basal and lateral nuclei, and the corticoamygdaloid transition area of the amygdala, the hippocampal-amygdaloid transition area and the granule cell and molecular layer of the dentate gyrus. Cortical thickness increased in the temporal, parietal and insular cortices of the right hemisphere. Conclusions Following ECT structural changes were observed in hippocampal subfields and amygdala nuclei that are specifically implicated in the pathophysiology of depression and stress-related disorders and retain a high potential for neuroplasticity in adulthood. Declaration of interest S.K. has received grants/research support, consulting fees and/or honoraria within the past 3 years from Angelini, AOP Orphan Pharmaceuticals AG, AstraZeneca, Celegne GmbH, Eli Lilly, Janssen-Cilag Pharma GmbH, KRKA-Pharma, Lundbeck A/S, Neuraxpharm, Pfizer, Pierre Fabre, Schwabe and Servier. R.L. received travel grants and/or conference speaker honoraria from Shire, AstraZeneca, Lundbeck A/S, Dr. Willmar Schwabe GmbH, Orphan Pharmaceuticals AG, Janssen-Cilag Pharma GmbH, and Roche Austria GmbH.