Amplitude-determined seizure-threshold, electric field modeling, and electroconvulsive therapy antidepressant and cognitive outcomes. New Study From New Mexico
Amplitude-determined seizure-threshold, electric field modeling, and electroconvulsive therapy antidepressant and cognitive outcomes.
Neuropsychopharmacology. 2024 Jan 11. doi: 10.1038/s41386-023-01780-4. Online ahead of print.PMID: 38212442
The abstract is copied below:
Electroconvulsive therapy (ECT) pulse amplitude, which dictates the induced electric field (E-field) magnitude in the brain, is presently fixed at 800 or 900 milliamperes (mA) without clinical or scientific rationale. We have previously demonstrated that increased E-field strength improves ECT's antidepressant effect but worsens cognitive outcomes. Amplitude-determined seizure titration may reduce the E-field variability relative to fixed amplitude ECT. In this investigation, we assessed the relationships among amplitude-determined seizure-threshold (STa), E-field magnitude, and clinical outcomes in older adults (age range 50 to 80 years) with depression. Subjects received brain imaging, depression assessment, and neuropsychological assessment pre-, mid-, and post-ECT. STa was determined during the first treatment with a Soterix Medical 4×1 High Definition ECT Multi-channel Stimulation Interface (Investigation Device Exemption: G200123). Subsequent treatments were completed with right unilateral electrode placement (RUL) and 800 mA. We calculated Ebrain defined as the 90th percentile of E-field magnitude in the whole brain for RUL electrode placement. Twenty-nine subjects were included in the final analyses. Ebrain per unit electrode current, Ebrain/I, was associated with STa. STa was associated with antidepressant outcomes at the mid-ECT assessment and bitemporal electrode placement switch. Ebrain/I was associated with changes in category fluency with a large effect size. The relationship between STa and Ebrain/I extends work from preclinical models and provides a validation step for ECT E-field modeling. ECT with individualized amplitude based on E-field modeling or STa has the potential to enhance neuroscience-based ECT parameter selection and improve clinical outcomes.
The article is here.
And from the text:
This is a very thoughtful, complex and well-carried out study. It is in the domain of ECT technique refinement. The idea of amplitude-determined seizure threshold is certainly intriguing and worth exploring. But, as the authors note, similar manipulations of the other stimulus parameters might potentially be equally useful.
These data also bring us back to the issue of the significance and etiology of the hippocampal enlargement seen with ECT.
In the big picture, ECT is very good already, and while incremental improvements are worth exploring, we must be careful not to exaggerate the significance of the (mostly transient) cognitive effects, and risk decreasing ECT's remarkable efficacy by offering weaker versions. I will also repeat that cognitive effects are tolerability, not safety, issues.
This study deserves a very careful read and probably a re-read to fully absorb its many aspects.
Big kudos to Dr. Abbott and colleagues for this impressive study!
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