ECT With Brain Cyst: Stimulation Simulation E-Field Study

Out on PubMed, from authors in Australia, in JECT, is this paper:


Electroconvulsive Therapy With Brain Cyst: A Simulation Study.

Ahmad Bakir A, Martin DM, Alduraywish A, Dokos S, Loo CK.J ECT. 2024 Jul 18. doi: 10.1097/YCT.0000000000001045. Online ahead of print.PMID: 39024187


 The abstract is copied below:

Introduction: Electroconvulsive therapy (ECT) is effective in treating severe depression and other neuropsychiatric disorders, but how the presence of an anatomical anomaly affects the electrical pathways between the electrodes remains unclear. We investigate the difference in electric field (E-field) distribution during ECT in the brain of a patient with an arachnoid cyst relative to hypothetical condition where the cyst was not present.

Methods: Magnetic resonance imaging scans of the head of a patient with a large left frontal cyst were segmented to construct a finite element model to study the E-field distribution during ECT. Five electrode configurations were investigated: right unilateral, left unilateral, bifrontal, and bitemporal and left anterior right temporal. The E-field distributions for all montages were compared with a hypothetical condition where brain tissue and electrical conductivity from the right frontal region was mirrored across the longitudinal fissure into the cyst.

Results: Differences in mean E-field and 90th percentile E-fields were mainly observed in brain regions closest to the cyst including the left inferior frontal gyrus and left middle frontal gyrus. This trend was most pronounced in montages where the electrodes were closest to the cyst such as left unilateral and bitemporal.

Conclusion: The presence of a highly conductive cyst close to the ECT electrode tended to attract current into the cyst region, altering current pathways, with potential implications for therapeutic efficacy and safety. Placing electrodes farther away from the cyst is likely to minimize any effects on the E-field distribution and potentially clinical outcomes.

The paper is here.
And from the text:















This is a very interesting theoretical study. It might even have some bearing on treatment planning (electrode placement and stimulus dosing) in the uncommon patient with a known arachnoid cyst.
Kudos to these authors for their careful investigation and to JECT for publishing it.


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