Computational models of Bitemporal, Bifrontal and Right Unilateral ECT predict differential stimulation of brain regions associated with efficacy and cognitive side effects

Extensive clinical research has shown that the efficacy and cognitive outcomes of electroconvulsive therapy (ECT) are determined, in part, by the type of electrode placement used. Bitemporal ECT (BT, stimulating electrodes placed bilaterally in the frontotemporal region) is the form of ECT with rela...

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Veröffentlicht in:	European psychiatry Jg. 41; H. 1; S. 21 - 29
Hauptverfasser:	Bai, S., Gálvez, V., Dokos, S., Martin, D., Bikson, M., Loo, C.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	England Elsevier Masson SAS 01.03.2017
Schlagworte:	Brain stimulation Cognition Cognition - physiology Cognitive Dysfunction - diagnosis Cognitive Dysfunction - etiology Cognitive Dysfunction - physiopathology Computational model Computer Simulation Deep Brain Stimulation - adverse effects Deep Brain Stimulation - methods Depression Efficacy Electroconvulsive therapy (ECT) Electroconvulsive Therapy - adverse effects Electroconvulsive Therapy - methods Finite Element Analysis Frontal Lobe - diagnostic imaging Frontal Lobe - physiopathology Humans Internal Medicine Magnetic Resonance Imaging Psychiatry Temporal Lobe - diagnostic imaging Temporal Lobe - physiopathology Treatment Outcome Depression Efficacy Cognition Brain stimulation Computational model Electroconvulsive therapy (ECT)
ISSN:	0924-9338, 1778-3585
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Abstract	Extensive clinical research has shown that the efficacy and cognitive outcomes of electroconvulsive therapy (ECT) are determined, in part, by the type of electrode placement used. Bitemporal ECT (BT, stimulating electrodes placed bilaterally in the frontotemporal region) is the form of ECT with relatively potent clinical and cognitive side effects. However, the reasons for this are poorly understood. This study used computational modelling to examine regional differences in brain excitation between BT, Bifrontal (BF) and Right Unilateral (RUL) ECT, currently the most clinically-used ECT placements. Specifically, by comparing similarities and differences in current distribution patterns between BT ECT and the other two placements, the study aimed to create an explanatory model of critical brain sites that mediate antidepressant efficacy and sites associated with cognitive, particularly memory, adverse effects. High resolution finite element human head models were generated from MRI scans of three subjects. The models were used to compare differences in activation between the three ECT placements, using subtraction maps. In this exploratory study on three realistic head models, Bitemporal ECT resulted in greater direct stimulation of deep midline structures and also left temporal and inferior frontal regions. Interpreted in light of existing knowledge on depressive pathophysiology and cognitive neuroanatomy, it is suggested that the former sites are related to efficacy and the latter to cognitive deficits. We hereby propose an approach using binarised subtraction models that can be used to optimise, and even individualise, ECT therapies.
AbstractList	Extensive clinical research has shown that the efficacy and cognitive outcomes of electroconvulsive therapy (ECT) are determined, in part, by the type of electrode placement used. Bitemporal ECT (BT, stimulating electrodes placed bilaterally in the frontotemporal region) is the form of ECT with relatively potent clinical and cognitive side effects. However, the reasons for this are poorly understood. This study used computational modelling to examine regional differences in brain excitation between BT, Bifrontal (BF) and Right Unilateral (RUL) ECT, currently the most clinically-used ECT placements. Specifically, by comparing similarities and differences in current distribution patterns between BT ECT and the other two placements, the study aimed to create an explanatory model of critical brain sites that mediate antidepressant efficacy and sites associated with cognitive, particularly memory, adverse effects. High resolution finite element human head models were generated from MRI scans of three subjects. The models were used to compare differences in activation between the three ECT placements, using subtraction maps. In this exploratory study on three realistic head models, Bitemporal ECT resulted in greater direct stimulation of deep midline structures and also left temporal and inferior frontal regions. Interpreted in light of existing knowledge on depressive pathophysiology and cognitive neuroanatomy, it is suggested that the former sites are related to efficacy and the latter to cognitive deficits. We hereby propose an approach using binarised subtraction models that can be used to optimise, and even individualise, ECT therapies. Abstract Background Extensive clinical research has shown that the efficacy and cognitive outcomes of electroconvulsive therapy (ECT) are determined, in part, by the type of electrode placement used. Bitemporal ECT (BT, stimulating electrodes placed bilaterally in the frontotemporal region) is the form of ECT with relatively potent clinical and cognitive side effects. However, the reasons for this are poorly understood. Objective This study used computational modelling to examine regional differences in brain excitation between BT, Bifrontal (BF) and Right Unilateral (RUL) ECT, currently the most clinically-used ECT placements. Specifically, by comparing similarities and differences in current distribution patterns between BT ECT and the other two placements, the study aimed to create an explanatory model of critical brain sites that mediate antidepressant efficacy and sites associated with cognitive, particularly memory, adverse effects. Methods High resolution finite element human head models were generated from MRI scans of three subjects. The models were used to compare differences in activation between the three ECT placements, using subtraction maps. Results and conclusion In this exploratory study on three realistic head models, Bitemporal ECT resulted in greater direct stimulation of deep midline structures and also left temporal and inferior frontal regions. Interpreted in light of existing knowledge on depressive pathophysiology and cognitive neuroanatomy, it is suggested that the former sites are related to efficacy and the latter to cognitive deficits. We hereby propose an approach using binarised subtraction models that can be used to optimise, and even individualise, ECT therapies. BACKGROUNDExtensive clinical research has shown that the efficacy and cognitive outcomes of electroconvulsive therapy (ECT) are determined, in part, by the type of electrode placement used. Bitemporal ECT (BT, stimulating electrodes placed bilaterally in the frontotemporal region) is the form of ECT with relatively potent clinical and cognitive side effects. However, the reasons for this are poorly understood.OBJECTIVEThis study used computational modelling to examine regional differences in brain excitation between BT, Bifrontal (BF) and Right Unilateral (RUL) ECT, currently the most clinically-used ECT placements. Specifically, by comparing similarities and differences in current distribution patterns between BT ECT and the other two placements, the study aimed to create an explanatory model of critical brain sites that mediate antidepressant efficacy and sites associated with cognitive, particularly memory, adverse effects.METHODSHigh resolution finite element human head models were generated from MRI scans of three subjects. The models were used to compare differences in activation between the three ECT placements, using subtraction maps.RESULTS AND CONCLUSIONIn this exploratory study on three realistic head models, Bitemporal ECT resulted in greater direct stimulation of deep midline structures and also left temporal and inferior frontal regions. Interpreted in light of existing knowledge on depressive pathophysiology and cognitive neuroanatomy, it is suggested that the former sites are related to efficacy and the latter to cognitive deficits. We hereby propose an approach using binarised subtraction models that can be used to optimise, and even individualise, ECT therapies.
Author	Gálvez, V. Bai, S. Martin, D. Bikson, M. Dokos, S. Loo, C.
Author_xml	– sequence: 1 givenname: S. surname: Bai fullname: Bai, S. organization: Department of Electrical and Computer Engineering, Technische Universität München, 80333 München, Germany – sequence: 2 givenname: V. surname: Gálvez fullname: Gálvez, V. organization: School of Psychiatry, UNSW, NSW 2052, Australia – sequence: 3 givenname: S. surname: Dokos fullname: Dokos, S. organization: Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales (UNSW), NSW 2052, Australia – sequence: 4 givenname: D. surname: Martin fullname: Martin, D. organization: School of Psychiatry, UNSW, NSW 2052, Australia – sequence: 5 givenname: M. surname: Bikson fullname: Bikson, M. organization: Department of Biomedical Engineering, The City College of The City University of New York, New York, USA – sequence: 6 givenname: C. surname: Loo fullname: Loo, C. email: colleen.loo@unsw.edu.au organization: School of Psychiatry, UNSW, NSW 2052, Australia
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Keywords	Depression Efficacy Cognition Brain stimulation Computational model Electroconvulsive therapy (ECT)
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Snippet	Extensive clinical research has shown that the efficacy and cognitive outcomes of electroconvulsive therapy (ECT) are determined, in part, by the type of... Abstract Background Extensive clinical research has shown that the efficacy and cognitive outcomes of electroconvulsive therapy (ECT) are determined, in part,... BACKGROUNDExtensive clinical research has shown that the efficacy and cognitive outcomes of electroconvulsive therapy (ECT) are determined, in part, by the...
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SubjectTerms	Brain stimulation Cognition Cognition - physiology Cognitive Dysfunction - diagnosis Cognitive Dysfunction - etiology Cognitive Dysfunction - physiopathology Computational model Computer Simulation Deep Brain Stimulation - adverse effects Deep Brain Stimulation - methods Depression Efficacy Electroconvulsive therapy (ECT) Electroconvulsive Therapy - adverse effects Electroconvulsive Therapy - methods Finite Element Analysis Frontal Lobe - diagnostic imaging Frontal Lobe - physiopathology Humans Internal Medicine Magnetic Resonance Imaging Psychiatry Temporal Lobe - diagnostic imaging Temporal Lobe - physiopathology Treatment Outcome
Title	Computational models of Bitemporal, Bifrontal and Right Unilateral ECT predict differential stimulation of brain regions associated with efficacy and cognitive side effects
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