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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Vydáno v:European psychiatry Ročník 41; číslo 1; s. 21 - 29
Hlavní autoři: Bai, S., Gálvez, V., Dokos, S., Martin, D., Bikson, M., Loo, C.
Médium: Journal Article
Jazyk:angličtina
Vydáno: England Elsevier Masson SAS 01.03.2017
Témata:
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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Shrnutí: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.
Bibliografie:ObjectType-Article-1
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ISSN:0924-9338
1778-3585
DOI:10.1016/j.eurpsy.2016.09.005