ECT current amplitude and medial temporal lobe engagement

ECT 电流幅度和内侧颞叶接合

• 批准号: 9228452
• 负责人: Christopher C Abbott
• 金额: $ 52.23万
• 依托单位: UNIVERSITY OF NEW MEXICO HEALTH SCIS CTR
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-26 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9228452
• 关键词: Adverse effects; Affect; Attention; Bilateral; Brain; Brain region; Characteristics; Charge; Clinical; Cognitive; Cognitive deficits; Data; Depressive disorder; Devices; Disease remission; Dose; Electroconvulsive Therapy; Electrodes; Exhibits; Frequencies; Generalized seizures; Goals; Gold; Handedness; Hippocampus (Brain); Impaired cognition; Individual; Individual Differences; Investigation; Left; Link; Lobe; Long-Term Potentiation; Magnetic Resonance Imaging; Measures; Medial; Mediating; Memory impairment; Mental Depression; Methods; Modeling; Moods; Neurocognitive; Neurocognitive Deficit; Neurofibrillary Tangles; Neuronal Plasticity; Outcome; Patients; Physiologic pulse; Physiological; Randomized; Regression Analysis; Research; Risk; Safety; Scalp structure; Seizures; Series; Staging; Stimulus; Symptoms; Temporal Lobe; Therapeutic Effect; Thick; Training; Treatment Efficacy; Width; Work; abstracting; antidepressant effect; brain tissue; cognitive change; cognitive function; cranium; depressed patient; depressive symptoms; dosage; electric field; entorhinal cortex; experience; improved; individual patient; neural circuit; neural correlate; neuroimaging; neuroregulation; older patient; response; standard care; suicidal; theories

1. Project Summary/Abstract Electroconvulsive therapy (ECT) remains the gold-standard treatment for patients with depressive episodes. During a typical four-week ECT series, most depressive episodes remit, and formerly suicidal or psychotically depressed patients will resume their premorbid levels of functioning. Independent of the antidepressant effect of ECT, many patients experience debilitating but transient cognitive effects such as attention and memory def- icits. These unwanted side effects are particularly troubling for older patients who are more likely to have exist- ing cognitive deficits. Both the stimulus delivery (electrode placement, pulse amplitude, and pulse width) and seizure induction appear to work in synergy, but the underlying mechanism of action for successful response has yet to be fully elucidated. Moreover, further work is needed to understand the relationship between clinical improvement and cognitive impairment. This investigation will examine the clinical and neurocognitive impact of targeted medial temporal lobe engagement as a function of pulse amplitude, one of several variable factors influencing the ECT charge. The ECT charge is measured in millicoulombs (mC) and derived from multiplying pulse train duration, pulse-pair frequency, pulse width, and pulse amplitude. Pulse amplitude determines the induced electric field strength in the brain and is presently fixed at 900 milliamperes (mA) with no clinical or scientific justification. The central hypothesis of this investigation is that the optimal pulse amplitude for an indi- vidual patient will enhance neuroplasticity (clinical response) while minimizing the disruption of dominant hemi- sphere hippocampal cognitive circuitry (resulting in cognitive stability). Our preliminary data informs the dosage range between 600 and 800 mA. Pulse amplitudes outside of this range compromise efficacy (500 mA) or may increase risk of cognitive impairment (900 mA). The first aim of this investigation will identify the electric field strength and neuroplasticity associated with clinical response. Critically, this aim will establish the neuroplas- ticity threshold, which is defined as the electric field strength necessary to induce neuroplasticity. The second aim will detect the neural correlates of ECT-mediated cognitive changes, which may be related to disrupted dominant hemisphere long-term potentiation. The third aim will use data-driven dual regression to predict the optimal pulse amplitude for an individual patient. This contribution will be significant because the electric field, when manipulated by pulse amplitude, can subsequently maximize hippocampal neuroplasticity (efficacy) and minimize disrupted connectivity (cognitive stability) thus improving clinical outcomes. 2 !

1.项目摘要/摘要 电休克治疗(ECT)仍然是抑郁症患者的黄金标准治疗方法。 在一个典型的为期四周的ECT系列赛中，大多数抑郁发作会缓解，以前是自杀或精神上的 抑郁症患者将恢复其发病前的功能水平。不依赖于抗抑郁作用 在ECT中，许多患者会经历衰弱但短暂的认知效果，如注意力和记忆障碍。 这是偶然的。这些不受欢迎的副作用对老年患者来说尤其令人担忧，他们更有可能存在- ING认知缺陷。刺激传递(电极位置、脉冲幅度和脉冲宽度)和 癫痫诱导似乎在协同作用中起作用，但成功反应的潜在作用机制 尚未完全阐明。此外，还需要进一步的工作来了解临床和临床之间的关系 改善和认知障碍。这项研究将检验临床和神经认知的影响。 作为脉冲幅度的函数的靶向内侧颞叶参与，这是几个可变因素之一 影响ECT充电。ECT电荷以毫库仑(MC)为单位测量，由乘法得出 脉冲串持续时间、脉冲对频率、脉冲宽度和脉冲幅度。脉冲幅度决定了 在大脑中感应的电场强度，目前固定在900毫安(MA)，没有临床或 科学论证。这项研究的中心假设是，一个指标的最优脉冲幅度是- 视觉患者将增强神经可塑性(临床反应)，同时最大限度地减少优势半球的干扰。 球形海马体认知回路(导致认知稳定性)。我们的初步数据告诉我们剂量 范围在600至800 Ma之间。超出此范围的脉冲幅度会影响疗效(500 MA)或可能 增加认知障碍的风险(900毫安)。这项研究的首要目标是确定电场。 强度和神经可塑性与临床反应相关。关键的是，这个目标将建立神经中枢- 可塑性阈值，定义为诱导神经可塑性所需的电场强度。第二 AIM将检测ECT介导的认知变化的神经关联，这可能与干扰有关 优势半球长时程增强。第三个目标将使用数据驱动的双重回归来预测 单个患者的最佳脉冲幅度。这一贡献将是巨大的，因为电场， 当通过脉冲幅度操纵时，随后可以最大限度地提高海马神经可塑性(有效性)和 最大限度地减少连接中断(认知稳定性)，从而改善临床结果。 2. 好了！