Grey Matter changes in treatment-resistant depression during electroconvulsive therapy

Yrondi, Antoine; Nemmi, Federico; Billoux, Sophie; Giron, Aurélie; Sporer, Marie; Taïb, Simon; Salles, Jean-Paul; Pierre, D.; Thalamas, Claire; Rigal, E.; Danet, Lola; Pariente, Jérémie; Schmitt, Laurent; Arbus, Christophe; Péran, Patrice

doi:10.1016/j.jad.2019.07.075

Cited by 28 publications

(30 citation statements)

References 32 publications

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“…In line with the literature [11,12,15,23,35,[41][42][43][44]61], all morphometry analyses consistently found both GM volume and cortical thickness increase following ECT, with the largest change in the right MTL. Multiple mechanisms may give rise to this GM expansion, including neuroplastic changes, changes in intracellular and extracellular fluid compartments (e.g., due to edema), immunological activation and altered cerebral blood flow [18,62].…”

Section: Differential Effect Of Ect On Gray and White Mattersupporting

confidence: 89%

“…From a methodological point of view, most previous studies have focused on ECT-related GMV changes using voxel-based morphometry (VBM) [41], surface-based morphometry (SBM) [15,[42][43][44], or region-of-interest (ROI) analysis [11,12,35,36], all of which rely on tissue segmentation. Deformation-based morphometry (DBM) is an alternative way to explore brain structural changes at a macroscopic level [45].…”

Section: Introductionmentioning

confidence: 99%

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Biophysical mechanisms of electroconvulsive therapy-induced volume expansion in the medial temporal lobe: a longitudinal in vivo human imaging study

Takamiya

Bouckaert

Laroy

et al. 2021

Preprint

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BackgroundElectroconvulsive therapy (ECT) applies electric currents to the brain to induce seizures for therapeutic purposes. ECT increases gray matter (GM) volume, predominantly in the medial temporal lobe (MTL). The contribution of induced seizures to this volume change remains unclear.MethodsT1-weighted structural MRI was acquired from thirty patients with late-life depression (mean age 72.5±7.9 years, 19 female), before and one week after one course of right unilateral ECT. Whole brain voxel-/deformation-/surface-based morphometry analyses were conducted to identify tissue-specific (GM, white matter: WM), and cerebrospinal fluid (CSF) and cerebral morphometry changes following ECT. Whole-brain voxel-wise electric field (EF) strength was estimated to investigate the association of EF distribution and regional brain volume change. The association between percentage volume change in the right MTL and ECT-related parameters (seizure duration, EF, and number of ECT sessions) was investigated using multiple regression.ResultsECT induced widespread GM volume expansion with corresponding contraction in adjacent CSF compartments, and limited WM change. The regional EF was strongly correlated with the distance from the electrodes, but not with regional volume change. The largest volume expansion was identified in the right MTL, and this was correlated with the total seizure duration.ConclusionsRight unilateral ECT induces widespread, bilateral regional volume expansion and contraction, with the largest change in the right MTL. This dynamic volume change cannot be explained by the effect of electrical stimulation alone and is related to the cumulative effect of ECT-induced seizures.

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Section: Differential Effect Of Ect On Gray and White Mattersupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Biophysical mechanisms of electroconvulsive therapy-induced volume expansion in the medial temporal lobe: a longitudinal in vivo human imaging study

Takamiya

Bouckaert

Laroy

et al. 2021

Preprint

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“…In the meta-regression analysis, we show positive correlations between percentage of patients suffering from unipolar depression and changes in right amygdala volumes. However, given that the vast majority of the subjects included in the reports were unipolar (six out of nine studies included 100% unipolar patients [12,16,21,25,93,94]), this might not represent a conclusive finding. There was no association between other moderators, especially regarding clinical outcomes, and volume changes in the amygdala.…”

Section: Amygdalamentioning

confidence: 99%

Meta-analysis of brain structural changes after electroconvulsive therapy in depression

et al. 2021

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Background: Increases in the volume of the amygdala and hippocampus after electroconvulsive therapy (ECT) are among the most robust effects known to the brain-imaging field. Recent advances in the segmentation of substructures of these regions allow for novel insights on the relationship between brain structure and clinical outcomes of ECT. Objective: We aimed to provide a comprehensive synthesis of evidence available on changes in brain structure after ECT, including recently published data on hippocampal subfields. Methods: A meta-analysis of published studies was carried out using random-effects models of standardized mean change of regional brain volumes measured with longitudinal magnetic resonance imaging of depressive patients before and after a series of ECT. Results: Data from 21 studies (543 depressed patients) were analysed, including 6 studies (118 patients) on hippocampal subfields. Meta-analyses could be carried out for seven brain regions for which data from at least three published studies was available. We observed increases in left and right hippocampi, amygdalae, cornua ammonis (CA) 1, CA 2/3, dentate gyri (DG) and subicula with standardized mean change scores ranging between 0.34 and 1.15. The model did not reveal significant volume increases in the caudate. Meta-regression indicated a negative relationship between the reported increases in the DG and relative symptom improvement (À0.27 (SE: 0.09) per 10%). Conclusions: ECT is accompanied by significant volume increases in the bilateral hippocampus and amygdala that are not associated with treatment outcome. Among hippocampal subfields, the most robust volume increases after ECT were measured in the dentate gyrus. The indicated negative correlation of this effect with antidepressant efficacy warrants replication in data of individual patients.

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“…Some of the earliest studies reported a correlation between baseline hippocampal volume or the hippocampal volumetric increase and the reduction in depressive symptoms (38,52). However, the majority of studies have failed to find an association (35,42,45,47,48,50,51,59,61,64,75). The lack of association could be related to the notion that the hippocampus is a heterogeneous entity.…”

Section: Mri Studies Of Ect In Depression T1 Structural Mrimentioning

confidence: 99%

The Neurobiological Effects of Electroconvulsive Therapy Studied Through Magnetic Resonance: What Have We Learned, and Where Do We Go?

Ousdal

Brancati

Keßler

et al. 2022

Biological Psychiatry

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Electroconvulsive therapy (ECT) is an established treatment choice for severe, treatment-resistant depression, yet its mechanisms of action remain elusive. Magnetic resonance imaging (MRI) of the human brain before and after treatment has been crucial to aid our comprehension of the ECT neurobiological effects. However, to date, a majority of MRI studies have been underpowered and have used heterogeneous patient samples as well as different methodological approaches, altogether causing mixed results and poor clinical translation. Hence, an association between MRI markers and therapeutic response remains to be established. Recently, the availability of large datasets through a global collaboration has provided the statistical power needed to characterize whole-brain structural and functional brain changes after ECT. In addition, MRI technological developments allow new aspects of brain function and structure to be investigated. Finally, more recent studies have also investigated immediate and long-term effects of ECT, which may aid in the separation of the therapeutically relevant effects from epiphenomena. The goal of this review is to outline MRI studies (T1, diffusion-weighted imaging, proton magnetic resonance spectroscopy) of ECT in depression to advance our understanding of the ECT neurobiological effects. Based on the reviewed literature, we suggest a model whereby the neurobiological effects can be understood within a framework of disruption, neuroplasticity, and rewiring of neural circuits. An improved characterization of the neurobiological effects of ECT may increase our understanding of ECT's therapeutic effects, ultimately leading to improved patient care.

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Grey Matter changes in treatment-resistant depression during electroconvulsive therapy

Cited by 28 publications

References 32 publications

Biophysical mechanisms of electroconvulsive therapy-induced volume expansion in the medial temporal lobe: a longitudinal in vivo human imaging study

Biophysical mechanisms of electroconvulsive therapy-induced volume expansion in the medial temporal lobe: a longitudinal in vivo human imaging study

Meta-analysis of brain structural changes after electroconvulsive therapy in depression

The Neurobiological Effects of Electroconvulsive Therapy Studied Through Magnetic Resonance: What Have We Learned, and Where Do We Go?

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