Cerebral and Brain Stem Changes After ECT Revealed by Nuclear Magnetic Resonance Imaging

Abstract

Nuclear magnetic resonance images of the brain were obtained in fourteen patients with major depression during a course of ECT. The T1 relaxation time rose immediately after the fit, reaching a maximum 4-6 h later. The T1 values then returned to their original level; no long-term increase occurred over the course of treatment. These results are consistent with an extensive but temporary breakdown of the blood-brain barrier during ECT.

Grey matter volume increase following electroconvulsive therapy in patients with late life depression: a longitudinal MRI study

“…8,56 However, our data cannot exclude alterations in water con tent, as we did not assess T 2 relaxation time following ECT. [47][48][49] Strikingly, the grey matter volume effects that we found in el derly patients were all in the proximity of spaces containing cerebrospinal fluid (i.e., lateral ventricle, choroid fissure, syl vian fissure). The vicinity of fluid and the transient intraictal breach in the blood-brain barrier 47 might facilitate local swell ing of adjacent brain tissue, which might explain the regional effects that we found.…”

“…Two possible underlying mechanisms are neuroplas ticity 46 and some kind of physiologic brain tissue reaction to the electric current, possibly associated with edema. [47][48][49] There are both animal and human studies that provide evi dence for electroconvulsive shock (ECS)/ECTrelated neuro plasticity, particularly in the hippocampus and amygdala, 46 areas in which we saw grey matter volume increase, but also in the frontal brain area. 50 Candidate cellular events underly ing changes detected by MRI in grey matter regions include axon sprouting, dendritic branching and synaptogenesis, neurogenesis, changes in glial number and morphology, and angiogenesis.…”

Bedeutung der bildgebenden Verfahren in der Beurteilung der Elektrokonvulsivtherapie

“…Auch Querschnittuntersuchungen sprachen gegen makroskopisch erfassbare, hirnstrukturelle Veränderungen unter EKT-Behandlung.Diese konnten keine signifikanten strukturellen Veränderungen nach einer einzelnen EKT-Sitzung [24,39] oder nach einer EKT-Serie [24,32] nachweisen (Übersicht in Devanand et al [9]). …”

The Use of Electroconvulsive Therapy in Special Patient Populations

“…Mag netic reso nance im ag ing (MRI) stud ies have in di cated that ECT in duces a tem po rary functional break down of the blood-brain bar rier, with in creased vas cu lar per me abil ity (91). This marked cere bral hy per per fusion in creases cere bral blood vol ume and puts per sons with brain tu mours who re ceive ECT at risk for brain her nia tion and pos si ble death (92). Small or chronic SOLs pose mini mal risk, un less as so ci ated with in creased ICP or other mass effects (93,94), where risk may be sub stan tial.…”