Electroconvulsive therapy and structural neuroplasticity in neocortical, limbic and paralimbic cortex.
Electroconvulsive therapy and structural neuroplasticity in neocortical, limbic and paralimbic cortex.
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DOI：
10.1038/tp.2016.102
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发表时间：
2016-06-07
影响因子：
6.8
通讯作者：
Narr KL
中科院分区：
文献类型：
--
作者：
Pirnia T;Joshi SH;Leaver AM;Vasavada M;Njau S;Woods RP;Espinoza R;Narr KL
电休克疗法（ECT）是一种高效、快速的治疗重度抑郁症的方法。为了了解治疗反应的生物学基础，我们检查了29例患者在ECT治疗指数系列中三个时间点扫描的磁共振成像（MRI）数据和29例对照组在两个时间点扫描的皮质厚度变化。在高空间分辨率下评价了整个皮质和感兴趣的离散皮质区域内随时间推移和症状改善的厚度变化。患者在ECT过程中显示双侧前扣带皮层（ACC）、颞叶下和上级、海马旁、内嗅和梭状皮层以及分布的前额叶区的厚度增加。对照组中未发生随时间的变化。在显示出显著ECT效应的颞叶和梭状区，患者和对照组之间的基线厚度不同，厚度变化与患者的治疗反应相关。在ACC中，这些关系仅发生在治疗应答者中，并且在治疗开始后不久测量的厚度预测了总体ECT应答。ECT导致新皮层、边缘系统和脑边缘系统区域的广泛神经可塑性，并且变化与抗抑郁反应的程度有关。ACC厚度的变化可以区分治疗反应者并预测ECT过程早期的反应，可能代表总体临床结果的生物标志物。由于尸检研究显示，严重抑郁症患者的神经胶质密度和神经元大小出现局灶性减少，因此ECT相关的厚度增加可能归因于影响神经元和神经胶质及其连接的大小和/或密度的神经可塑性过程。
Electroconvulsive therapy (ECT) is a highly effective and rapidly acting treatment for severe depression. To understand the biological bases of therapeutic response, we examined variations in cortical thickness from magnetic resonance imaging (MRI) data in 29 patients scanned at three time points during an ECT treatment index series and in 29 controls at two time points. Changes in thickness across time and with symptom improvement were evaluated at high spatial resolution across the cortex and within discrete cortical regions of interest. Patients showed increased thickness over the course of ECT in the bilateral anterior cingulate cortex (ACC), inferior and superior temporal, parahippocampal, entorhinal and fusiform cortex and in distributed prefrontal areas. No changes across time occurred in controls. In temporal and fusiform regions showing significant ECT effects, thickness differed between patients and controls at baseline and change in thickness related to therapeutic response in patients. In the ACC, these relationships occurred in treatment responders only, and thickness measured soon after treatment initiation predicted the overall ECT response. ECT leads to widespread neuroplasticity in neocortical, limbic and paralimbic regions and changes relate to the extent of antidepressant response. Variations in ACC thickness, which discriminate treatment responders and predict response early in the course of ECT, may represent a biomarker of overall clinical outcome. Because post-mortem studies show focal reductions in glial density and neuronal size in patients with severe depression, ECT-related increases in thickness may be attributable to neuroplastic processes affecting the size and/or density of neurons and glia and their connections.