Out on Pubmed today is another important neuroimaging study from the Global ECT-MRI Research Collaboration (GEMRIC):
Structural changes induced by electroconvulsive therapy are associated with clinical outcome. Mulders PCR, Llera A, Beckmann CF, Vandenbulcke M, Stek M, Sienaert P, Redlich R, Petrides G, Oudega ML, Oltedal L, Oedegaard KJ, Narr KL, Magnusson PO, Kessler U, Jorgensen A, Espinoza R, Enneking V, Emsell L, Dols A, Dannlowski U, Bolwig TG, Bartsch H, Argyelan M, Anand A, Abbott CC, van Eijndhoven PFP, Tendolkar I.
Brain Stimul. 2020 Feb 21;13(3):696-704. doi: 10.1016/j.brs.2020.02.020. [Epub ahead of print]
PMID: 32289700
The pdf is here.
Data are from scans of 192 patients (120 responders, 72 non responders). The study looks at two things: structural changes related to treatment response and to electrode placement.
Brain Stimul. 2020 Feb 21;13(3):696-704. doi: 10.1016/j.brs.2020.02.020. [Epub ahead of print]
PMID: 32289700
The pdf is here.
Data are from scans of 192 patients (120 responders, 72 non responders). The study looks at two things: structural changes related to treatment response and to electrode placement.
They show 75% accuracy to classify treatment response (sensitivity 84%, specificity 60%).
Increased volumes of right precuneus, right supramarginal gyrus and right caudal ACC (among other regions) were indicative of response.
The authors note:
"Regions identified as contributing to response are located in cortical midline, striatal and lateral prefrontal areas implicated in the pathophysiology of depression. In addition, we dissociate regions related to treatment response from those related to site of electrical stimulation by showing that the type of ECT used (unilateral or bilateral) can be identified by a discriminative map that incorporates unilateral medial temporal regions that are known to be affected by ECT."
In their discussion of the findings, they state:
"Taken together, it is likely that not one but multiple neuroplastic systems are engaged during and after ECT and operate on varying timescales to affect both short and longer-term changes in structure and function. How these neuroplastic changes can help to overcome depression is still largely unknown, but one possibility is that this forging or restoring of connections within large scale networks that are dysfunctional in depression helps to overcome depressogenic pathways."
The authors note:
"Regions identified as contributing to response are located in cortical midline, striatal and lateral prefrontal areas implicated in the pathophysiology of depression. In addition, we dissociate regions related to treatment response from those related to site of electrical stimulation by showing that the type of ECT used (unilateral or bilateral) can be identified by a discriminative map that incorporates unilateral medial temporal regions that are known to be affected by ECT."
In their discussion of the findings, they state:
"Taken together, it is likely that not one but multiple neuroplastic systems are engaged during and after ECT and operate on varying timescales to affect both short and longer-term changes in structure and function. How these neuroplastic changes can help to overcome depression is still largely unknown, but one possibility is that this forging or restoring of connections within large scale networks that are dysfunctional in depression helps to overcome depressogenic pathways."
The importance of the study is it the first to tease out the relationship between structural brain changes and clinical response. The authors tout their multivariate discriminant analysis method as the main reason this study is so powerful.
This is groundbreaking research, but it is still preliminary. The number of patients, while large, is not huge, and these findings will need to be replicated. I hope GEMRIC will continue to thrive and contribute to the ECT literature.
CK
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