Mechanisms of Antidepressant Response to Electroconvulsive Therapy Studied With Perfusion Magnetic Resonance Imaging.

Autor: Leaver AM; Ahmanson-Lovelace Brain Mapping Center, University of California Los Angeles, Los Angeles, California; Department of Radiology, Northwestern University, Chicago, Illinois. Electronic address: amber.leaver@northwestern.edu., Vasavada M; Ahmanson-Lovelace Brain Mapping Center, University of California Los Angeles, Los Angeles, California., Joshi SH; Ahmanson-Lovelace Brain Mapping Center, University of California Los Angeles, Los Angeles, California., Wade B; Ahmanson-Lovelace Brain Mapping Center, University of California Los Angeles, Los Angeles, California., Woods RP; Ahmanson-Lovelace Brain Mapping Center, University of California Los Angeles, Los Angeles, California; Department of Neurology, and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California., Espinoza R; Department of Neurology, and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California., Narr KL; Ahmanson-Lovelace Brain Mapping Center, University of California Los Angeles, Los Angeles, California; Department of Neurology, and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California.
Jazyk: angličtina
Zdroj: Biological psychiatry [Biol Psychiatry] 2019 Mar 15; Vol. 85 (6), pp. 466-476. Date of Electronic Publication: 2018 Oct 05.
DOI: 10.1016/j.biopsych.2018.09.021
Abstrakt: Background: Converging evidence suggests that electroconvulsive therapy (ECT) induces neuroplasticity in patients with severe depression, though how this relates to antidepressant response is less clear. Arterial spin-labeled functional magnetic resonance imaging tracks absolute changes in cerebral blood flow (CBF) linked with brain function and offers a potentially powerful tool when observing neurofunctional plasticity with functional magnetic resonance imaging.
Methods: Using arterial spin-labeled functional magnetic resonance imaging, we measured global and regional CBF associated with clinically prescribed ECT and therapeutic response in patients (n = 57, 30 female) before ECT, after two treatments, after completing an ECT treatment "index" (∼4 weeks), and after long-term follow-up (6 months). Age- and sex-matched control subjects were also scanned twice (n = 36, 19 female), ∼4 weeks apart.
Results: Patients with lower baseline global CBF were more likely to respond to ECT. Regional CBF increased in the right anterior hippocampus in all patients irrespective of clinical outcome, both after 2 treatments and after ECT index. However, hippocampal CBF increases postindex were more pronounced in nonresponders. ECT responders exhibited CBF increases in the dorsomedial thalamus and motor cortex near the vertex ECT electrode, as well as decreased CBF within lateral frontoparietal regions.
Conclusions: ECT induces functional neuroplasticity in the hippocampus, which could represent functional precursors of ECT-induced increases in hippocampal volume reported previously. However, excessive functional neuroplasticity within the hippocampus may not be conducive to positive clinical outcome. Instead, our results suggest that although hippocampal plasticity may contribute to antidepressant response in ECT, balanced plasticity in regions relevant to seizure physiology including thalamocortical networks may also play a critical role.
(Copyright © 2018 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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