Structural and functional neuroimaging of electroconvulsive therapy and transcranial magnetic stimulation

Nobler, Mitchell S.; Tenebäck, Charlotte C.; Nahas, Ziad; Bohning, Daryl E.; Shastri, Ananda; Kozel, F. Andrew; George, Mark S.

doi:10.1002/1520-6394(2000)12:3<144::aid-da6>3.0.co;2-#

Cited by 29 publications

(9 citation statements)

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“…Less consistency is found regarding the reversibility of abnormalities in rCBF and in cerebral metabolic rate for glucose in depression after electroconvulsive therapy (ECT). Studies that addressed the immediate and acute effects of ECT (e.g., 30 min to 24 h after treatment) disclosed mainly reductions in rCBF and cerebral metabolic rate, whereas when imaging took place some days after ECT, reversal of major depressive disorder (MDD) abnormalities was often found (7)(8)(9). Still, even when imaging was performed at the later stage, reductions (10) or no change (11) in rCBF or cerebral metabolic rate were noted.…”

mentioning

confidence: 99%

99mTc-HMPAO SPECT Study of Cerebral Perfusion After Treatment with Medication and Electroconvulsive Therapy in Major Depression

Kohn

Freedman²,

Lester³

et al. 2007

Journal of Nuclear Medicine

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Compromised regional cerebral blood flow (rCBF) in major depressive disorder may be partly reversed by successful antidepressant treatment. However, it is not known if the reversal of rCBF compromise is dependant on the mode of antidepressant treatment. The current study aimed to address this question. Methods: Thirty-three patients (19 women and 14 men; mean age 6 SD, 53 6 16 y) with moderate major depressive disorder were studied before 6 wk of treatment with tricyclic antidepressants, selective serotonin reuptake inhibitors, or a course of electroconvulsive therapy, and 31 of these patients were also studied afterward. A comparison group of 25 healthy volunteers (13 women and 12 men; mean age, 49 6 15 y) were studied once. rCBF was assessed using 99m Tc-hexamethylpropyleneamine oxime SPECT. Images were analyzed using globally normalized statistical parametric mapping localized to the Montreal Neurologic Institute brain atlas. Results: Baseline rCBF was lower in depressed patients than in controls in the frontal cortex and subcortical nuclei bilaterally. A response to medication was associated with normalization of rCBF deficits, whereas a response to electroconvulsive therapy was associated with an additional rCBF decrease in the parietotemporal and cerebellar regions bilaterally. Conclusion: Hypoperfusion in major depressive disorder largely normalizes after a response to pharmacotherapy. Perfusion changes after a response to electroconvulsive therapy may follow a different course. Earl y functional neuroimaging studies comparing healthy and depressed subjects reported decreases in regional cerebral blood flow (rCBF) and metabolism typically in the frontal and prefrontal regions but also in temporal, parietal, and limbic-subcortical structures (1-3). More recent studies have presented a more diverse and complex picture, replicating but also extending the findings of earlier studies (1,2). These studies distinguished between ventral frontal and prefrontal regions that display increased metabolism or perfusion in depressed patients and more rostral regions within the cingulate gyrus and dorsolateral prefrontal cortex that show decreased perfusion. In other regions postulated to play a role in the pathophysiology of depression, such as the limbic and paralimbic regions and the basal ganglia, findings have been inconsistent (1,2). This diversity in brain imaging findings may reflect the heterogeneity between studies in age of subjects, group size, male-to-female ratio, subtype and severity of psychopathology, and medication status. The choice of imaging technique, radiopharmaceutical, acquisition parameters, and processing parameters also have varied considerably, as have the method of data analysis and choice of reference region.rCBF alterations in depression generally normalize after a response to treatment with medication, interpersonal psychotherapy, or a placebo (2,4) (but a different pattern of perfusion changes is seen in response to venlafaxine (5) or cognitive behavioral therapy (6)). Less consistency i...

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mentioning

confidence: 99%

99mTc-HMPAO SPECT Study of Cerebral Perfusion After Treatment with Medication and Electroconvulsive Therapy in Major Depression

Kohn

Freedman²,

Lester³

et al. 2007

Journal of Nuclear Medicine

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“…Some authors, however, found that there may be an association between the excitability of the prefrontal and motor cortex, suggesting that MT determination could be preserved (Kahkonen et al 2004). An alternative to the motor measure is to calculate the dose based on a formula which takes into account the individual distance from scalp to prefrontal cortex (measured with MRI) and the exponential drop in magnetic field strength with increasing distance from the coil Kozel et al 2000;Nobler et al 2000;McConnell et al 2001). The influence of different stimulation frequencies (1Á/20 Hz) is closely related to laterality in brain mood systems, as discussed above.…”

Section: Meta-analysesmentioning

confidence: 93%

“…Deeper situated neurons probably can become activated indirectly via cortical interconnections and redundant cortical Á/subcortical loops. Functional neuro-imaging studies, hormonal changes and changes in brain metabolism after TMS support this hypothesis (Alexander et al 1986;George et al 1996b;Bohning et al 1999;Nobler et al 2000;George et al 2002George et al , 2003.…”

Section: Standard Procedures Tms In Psychiatrymentioning

confidence: 99%

“…When fast oscillating magnetic fields are applied, electrical energy is transported through the brain, resulting in changes in neuronal activity. This current (12Á/20 mA/cm 2 ) is of the same size-order as the one used in conventional electric brain stimulations (Epstein 1990;Sackeim 1994;Nobler et al 2000;Wagner et al 2004). Compared with the latter, during TMS no energy is lost in resistance of haired skin, soft tissues and the skull.…”

Section: Introductionmentioning

confidence: 99%

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Transcranial magnetic stimulation as a therapeutic tool in psychiatry

Simons

Dierick²

2005

The World Journal of Biological Psychiatry

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Transcranial magnetic stimulation (TMS) is a patient-friendly stimulation technique of the brain with interesting perspectives. In clinical psychiatry, limited data are available on activity in psychosis and anxiety, but much research has been done in depression. Major concerns on published papers are the inconsistency of used parameter settings, the restraint numbers of patients in randomised trials, the lack of real sham controlled studies and the quasi inexistent reproducibility of results. The most stringent meta-analysis of TMS in affective disorders found a modest, statistically significant antidepressant effect after 2 weeks of daily treatment of high frequency repetitive left dorsolateral prefrontal cortex stimulation. Although most results are rather weak and not convincing enough to promote TMS as evidence-based antidepressive therapy, they show a measurable action that should not be ignored. Preclinical and clinical effects were observed analysing heterogeneous data, and results comparing TMS to electroconvulsive therapy (ECT) in affective disorders are encouraging. Efforts should continue with emphasis on increasing homogeneity and reproducibility in data. Further refinement of stimulation parameters should be established, so that new and large double-blind, long-term, sham-controlled trials can bring us to better understanding and standardising TMS procedure, finally leading to definitive conclusions about its efficacy in psychiatry.

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“…Eine kürzlich erschienene Studie,die mit der 133 Xe-Inhalationstechnik an depressiven und manischen Patienten durchgeführt wurde,zeigte erstmalig, dass die Reduktion des CBF in präfrontalen Regionen 50 min nach einer einzelnen EKT-Behandlung im Vergleich zur Voruntersuchung 30 min vor der EKT mit einem besseren klinischen Ansprechen verbunden war. Durch den Abfall des CBF nach einer EKT konnten 68% der Responder und 85% der Nonresponder korrekt klassifiziert werden [30]. Damit könnte die Unterdrückung des zerebralen Blutflusses direkt nach einer EKT einen Prädiktor für den Therapieerfolg mit einer EKT-Serie darstellen.…”

Section: Funktionelle Untersuchungenunclassified

Bedeutung der bildgebenden Verfahren in der Beurteilung der Elektrokonvulsivtherapie

2004

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Magnetic resonance imaging (MRI), positron emission tomography (PET), and single photon emission computed tomography (SPECT) may be able to investigate the clinical efficacy and underlying neuronal processes of electroconvulsive therapy (ECT). The following review focuses on neuroimaging in ECT. Neuroimaging findings support that ECT does not result in significant macroscopic structural changes. However, in patients with subtle structural changes such as subcortical lesions and dilatation of lateral ventricles before ECT, the possibilities of poor therapeutic outcome, increased incidence of delirium, and longer-lasting cognitive deficits should be considered. Functional studies show reduced blood flow and glucose metabolism during the first days after ECT. Afterwards, their normalization can be observed, which seems to correlate to clinical improvement. The importance of this suppression effect needs to be further elucidated. Future studies of receptor systems and longitudinal studies will open new perspectives in future imaging research.

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Structural and functional neuroimaging of electroconvulsive therapy and transcranial magnetic stimulation

Cited by 29 publications

References 50 publications

99mTc-HMPAO SPECT Study of Cerebral Perfusion After Treatment with Medication and Electroconvulsive Therapy in Major Depression

99mTc-HMPAO SPECT Study of Cerebral Perfusion After Treatment with Medication and Electroconvulsive Therapy in Major Depression

Transcranial magnetic stimulation as a therapeutic tool in psychiatry

Bedeutung der bildgebenden Verfahren in der Beurteilung der Elektrokonvulsivtherapie

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