Variations in myo-inositol in fronto-limbic regions and clinical response to electroconvulsive therapy in major depression.
Variations in myo-inositol in fronto-limbic regions and clinical response to electroconvulsive therapy in major depression.
复制标题
DOI：
10.1016/j.jpsychires.2016.05.012
复制
发表时间：
2016-09
影响因子：
4.8
通讯作者：
Narr KL
中科院分区：
文献类型：
--
作者：
Njau S;Joshi SH;Leaver AM;Vasavada M;Van Fleet J;Espinoza R;Narr KL
虽然电休克疗法（ECT）是一种治疗严重抑郁症的既定疗法，但其临床疗效的神经生物学因素在很大程度上尚不清楚。肌醇，一种与神经胶质活性相关的神经代谢物，据报道在抑郁症患者的额边缘区减少。肌醇的变化是否与ECT的抗抑郁作用有关尚不清楚。采用磁共振波谱（1H-MRS）技术，对50例ECT患者（平均年龄43.78，14 SD）和33例对照者（平均年龄39.33，12 SD）的背内侧前扣带皮层（dmACC）和左右海马肌醇进行测量，以确定ECT诊断的横向效应和纵向效应。患者在治疗前、第二次ECT后和ECT指数系列完成时进行扫描。对照组以对应于患者基线和治疗结束扫描的间隔扫描两次。在dmACC中，肌醇在ECT过程中增加（p = 0.042）。观察到海马（p=0.003）具有显著的临床反应半球效应，其中肌醇减少与左侧海马的症状改善相关。未检测到基线时患者和对照组之间的横截面差异。在dmACC中观察到的肌醇变化与ECT相关，在海马中观察到的肌醇变化与ECT相关的临床反应相关，表明ECT的机制可能包括胶质细胞生成或胶质细胞增生的逆转，其差异性地影响背侧和腹侧边缘区域。dmACC肌醇的变化与对照值不同，ECT提示代偿，而海马变化提示正常化。
Though electroconvulsive therapy (ECT) is an established treatment for severe depression, the neurobiological factors accounting for the clinical effects of ECT are largely unknown. Myo-inositol, a neurometabolite linked with glial activity, is reported as reduced in fronto-limbic regions in patients with depression. Whether changes in myo-inositol relate to the antidepressant effects of ECT is unknown. Using magnetic resonance spectroscopy (1H-MRS), we measured dorsomedial anterior cingulate cortex (dmACC) and left and right hippocampal myo-inositol in 50 ECT patients (mean age: 43.78, 14 SD) and 33 controls (mean age: 39.33, 12 SD) to determine cross sectional effects of diagnosis and longitudinal effects of ECT. Patients were scanned prior to treatment, after the second ECT and at completion of the ECT index series. Controls were scanned twice at intervals corresponding to patients’ baseline and end of treatment scans. Myo-inositol increased over the course of ECT in the dmACC (p = 0.042). A significant hemisphere by clinical response effect was observed for the hippocampus (p=0.003) where decreased myo-inositol related to symptom improvement in the left hippocampus. Cross-sectional differences between patients and controls at baseline were not detected. Changes in myo-inositol observed in the dmACC in association with ECT and in the hippocampus in association with ECT-related clinical response suggest the mechanisms of ECT could include gliogenesis or a reversal of gliosis that differentially affect dorsal and ventral limbic regions. Change in dmACC myo-inositol diverged from control values with ECT suggesting compensation, while hippocampal change suggested normalization.