Electroconvulsive therapy, electric field, neuroplasticity, and clinical outcomes.
Electroconvulsive therapy, electric field, neuroplasticity, and clinical outcomes.
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DOI：
10.1038/s41380-021-01380-y
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发表时间：
2022-03
影响因子：
11
通讯作者：
Abbott, Christopher C.
中科院分区：
文献类型：
--
作者：
Deng, Zhi-De;Argyelan, Miklos;Miller, Jeremy;Quinn, Davin K.;Lloyd, Megan;Jones, Thomas R.;Upston, Joel;Erhardt, Erik;McClintock, Shawn M.;Abbott, Christopher C.
电休克疗法（ECT）仍是治疗抑郁发作患者的金标准疗法，但其抗抑郁疗效及治疗引发认知副作用的潜在机制尚未阐明。这些机制可能较为复杂，涉及某些ECT参数及脑区。就参数而言，电极放置方式（右侧单侧或双侧颞部）决定电场（E场）的几何形状，而振幅则决定特定脑区（如海马体）的电场强度。在此，我们旨在确定海马体电场强度、海马体神经可塑性以及抗抑郁和认知结果之间的关系。我们采用了一项随机临床试验中生成的海马体电场和体积数据，该试验对比了不同脉冲振幅（600、700和800毫安）下的右侧单侧电极放置情况。海马体电场强度存在差异，但随各振幅组升高。我们证实了右侧海马体电场与右侧海马体神经可塑性之间存在线性关系。右侧海马体神经可塑性介导了右侧海马体电场与抗抑郁结果之间的联系。相比之下，右侧海马体电场与通过语音流畅性测量的认知结果直接相关。我们利用受试者工作特征曲线确定，与认知安全性相关的右侧海马体最大电场为112.5伏/米。右侧海马体电场强度与每单位刺激电流的全脑电场强度比率相关，但该全脑比率与抗抑郁或认知结果无关。我们探讨了最佳海马体电场剂量对于通过个体化振幅实现抗抑郁效果最大化及认知安全性的意义。
Electroconvulsive therapy (ECT) remains the gold-standard treatment for patients with depressive episodes, but the underlying mechanisms for antidepressant response and procedure-induced cognitive side effects have yet to be elucidated. Such mechanisms may be complex and involve certain ECT parameters and brain regions. Regarding parameters, the electrode placement (right unilateral or bitemporal) determines the geometric shape of the electric field (E-field), and amplitude determines the E-field magnitude in select brain regions (e.g., hippocampus). Here, we aim to determine the relationships between hippocampal E-field strength, hippocampal neuroplasticity, and antidepressant and cognitive outcomes. We used hippocampal E-fields and volumes generated from a randomized clinical trial that compared right unilateral electrode placement with different pulse amplitudes (600, 700, and 800 mA). Hippocampal E-field strength was variable but increased with each amplitude arm. We demonstrated a linear relationship between right hippocampal E-field and right hippocampal neuroplasticity. Right hippocampal neuroplasticity mediated right hippocampal E-field and antidepressant outcomes. In contrast, right hippocampal E-field was directly related to cognitive outcomes as measured by phonemic fluency. We used receiver operating characteristic curves to determine that the maximal right hippocampal E-field associated with cognitive safety was 112.5 V/m. Right hippocampal E-field strength was related to the whole-brain ratio of E-field strength per unit of stimulation current, but this whole-brain ratio was unrelated to antidepressant or cognitive outcomes. We discuss the implications of optimal hippocampal E-field dosing to maximize antidepressant outcomes and cognitive safety with individualized amplitudes.
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DOI：
10.1080/10705519909540118
发表时间：
1999-01-01
影响因子：
6
作者：
Hu, Li-tze;Bentler, Peter M.
通讯作者：
Bentler, Peter M.
影响因子：
2.5
作者：
Deng Zhi-De;Lisanby, Sarah H.;Peterchev, Angel, V
通讯作者：
Peterchev, Angel, V
影响因子：
10.5
作者：
Gryglewski, Gregor;Baldinger-Melich, Pia;Lanzenberger, Rupert
通讯作者：
Lanzenberger, Rupert
影响因子：
5.7
作者：
Fischl, Bruce
通讯作者：
Fischl, Bruce
影响因子：
7.7
作者：
Argyelan, Miklos;Oltedal, Leif;Abbott, Christopher
通讯作者：
Abbott, Christopher