Meta-analysis of brain structural changes after electroconvulsive therapy in depression
Meta-analysis of brain structural changes after electroconvulsive therapy in depression
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DOI：
10.1016/j.brs.2021.05.014
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发表时间：
2021-06-15
影响因子：
7.7
通讯作者：
Baldinger-Melich, Pia
中科院分区：
文献类型：
--
作者：
Gryglewski, Gregor;Lanzenberger, Rupert;Baldinger-Melich, Pia
背景：电休克治疗(ECT)后杏仁核和海马体体积的增加是脑成像领域已知的最强烈的影响之一。这些区域的亚结构分割的最新进展使我们能够对脑结构与ECT临床结果之间的关系有新的认识。目的：我们旨在提供关于ECT后脑结构变化的现有证据的综合，包括最近发表的关于海马区的数据。方法：对已发表的研究进行荟萃分析，利用纵向磁共振成像测量抑郁症患者在一系列ECT前后的标准化的区域脑体积平均变化的随机效应模型。结果：分析了21项研究(543例抑郁症患者)的数据，其中包括6项关于海马区的研究(118例)。可以对至少有三项已发表研究的数据的七个大脑区域进行荟萃分析。我们观察到左侧和右侧海马区、杏仁核、羊角(CA)1、CA2/3、齿状回(DG)和下丘脑的增加，标准化平均变化分数在0.34到1.15之间。该模型没有显示尾状核体积的显著增加。Meta回归分析显示DG增加与相对症状改善呈负相关(-0.27(SE：0.09)/10%)。结论：ECT伴有双侧海马和杏仁核体积的显著增加，与治疗结果无关。在海马区中，ECT后最强劲的体积增加是在齿状回。这一效应与抗抑郁药疗效的负相关值得在个别患者的数据中复制。(C)2021年提交人。由爱思唯尔公司出版。
Background: Increases in the volume of the amygdala and hippocampus after electroconvulsive therapy (ECT) are among the most robust effects known to the brain-imaging field. Recent advances in the segmentation of substructures of these regions allow for novel insights on the relationship between brain structure and clinical outcomes of ECT.Objective: We aimed to provide a comprehensive synthesis of evidence available on changes in brain structure after ECT, including recently published data on hippocampal subfields.Methods: A meta-analysis of published studies was carried out using random-effects models of standardized mean change of regional brain volumes measured with longitudinal magnetic resonance imaging of depressive patients before and after a series of ECT.Results: Data from 21 studies (543 depressed patients) were analysed, including 6 studies (118 patients) on hippocampal subfields. Meta-analyses could be carried out for seven brain regions for which data from at least three published studies was available. We observed increases in left and right hippocampi, amygdalae, cornua ammonis (CA) 1, CA 2/3, dentate gyri (DG) and subicula with standardized mean change scores ranging between 0.34 and 1.15. The model did not reveal significant volume increases in the caudate. Meta-regression indicated a negative relationship between the reported increases in the DG and relative symptom improvement (-0.27 (SE: 0.09) per 10%).Conclusions: ECT is accompanied by significant volume increases in the bilateral hippocampus and amygdala that are not associated with treatment outcome. Among hippocampal subfields, the most robust volume increases after ECT were measured in the dentate gyrus. The indicated negative correlation of this effect with antidepressant efficacy warrants replication in data of individual patients. (C) 2021 The Authors. Published by Elsevier Inc.