Electroconvulsive Treatment: Hypotheses about Mechanisms of Action.
Electroconvulsive Treatment: Hypotheses about Mechanisms of Action.
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DOI：
10.3389/fpsyt.2013.00094
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发表时间：
2013
影响因子：
4.7
通讯作者：
Read J
中科院分区：
文献类型：
--
作者：
Fosse R;Read J
关于电休克治疗（ECT）的作用方式尚未达成共识。我们认为两个特征可能有助于描述所涉及的机制。首先，当ECT有效时，它可能会影响大脑功能，而这些功能在其主要接受者群体（严重抑郁症患者）中通常会发生改变。其中的中心是额叶和颞叶，下丘脑-垂体-肾上腺（HPA）压力轴和中皮质边缘多巴胺系统。其次，所涉及的机制受到影响的时间应与临床效果的平均持续时间相匹配，一般为几天到几周。为了确定对额叶和颞叶功能的影响，我们回顾了使用脑电图、PET、SPECT和功能磁共振成像的人类研究。对HPA轴和多巴胺系统的影响通过回顾人类和动物研究来评估。脑电图研究表明，电痉挛疗法会使额叶和颞叶的神经活动减慢（增加δ波和θ波活动），持续数周至数月。PET和SPECT研究报告了类似的结果，治疗后数周至数月脑血流量减少（功能失活）。ECT后脑电图减速和功能失活与抑郁评分降低有统计学意义。功能磁共振成像研究表明，ECT使与认知任务表现相关的激活和失活模式变平，并改变了超慢频率范围内皮层功能连接。人类和动物研究的一个共同发现是，电痉挛疗法会强烈激活下丘脑轴和多巴胺系统。考虑到这一证据，我们假设电痉挛疗法影响大脑的方式与严重的压力或脑外伤类似，后者会激活下丘脑轴和多巴胺系统，并可能损害额颞叶功能。
No consensus has been reached on the mode of action of electroconvulsive treatment (ECT). We suggest that two features may aid in the delineation of the involved mechanisms. First, when effective, ECT would be likely to affect brain functions that are typically altered in its primary recipient group, people with severe depression. Central among these are the frontal and temporal lobes, the hypothalamus-pituitary-adrenal (HPA) stress axis, and the mesocorticolimbic dopamine system. Second, the involved mechanisms should be affected for a time period that matches the average endurance of clinical effects, which is indicated to be several days to a few weeks. To identify effects upon frontal and temporal lobe functioning we reviewed human studies using EEG, PET, SPECT, and fMRI. Effects upon the HPA axis and the dopamine system were assessed by reviewing both human and animal studies. The EEG studies indicate that ECT decelerates neural activity in the frontal and temporal lobes (increased delta and theta wave activity) for weeks to months. Comparable findings are reported from PET and SPECT studies, with reduced cerebral blood flow (functional deactivation) for weeks to months after treatment. The EEG deceleration and functional deactivation following ECT are statistically associated with reduced depression scores. FMRI studies indicate that ECT flattens the pattern of activation and deactivation that is associated with cognitive task performance and alters cortical functional connectivity in the ultra slow frequency range. A common finding from human and animal studies is that ECT acutely activates both the HPA axis and the dopamine system. In considering this evidence, we hypothesize that ECT affects the brain in a similar manner as severe stress or brain trauma which activates the HPA axis and the dopamine system and may compromise frontotemporal functions.