Study of the influence of electroconvulsive therapy on the regional cerebral blood flow by HMPAO-SPECT

Elizagárate, Edorta; Cortés, Julia Tamara Álvarez; Pinto, Ana González; Gutiérrez, Miguel; Alonso, I.; Alcorta, P.; Ramírez, Maite; Heredia, J.L Pz de; Figuerido, J.L.

doi:10.1016/s0165-0327(00)00200-7

Cited by 18 publications

(6 citation statements)

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“…The involvement of the whole brain in mECS is confirmed in the present study by the widespread increase in LCBF rates during the seizure. Our data are in accordance with previous studies reporting generalized increase in LCBF rates or cerebral metabolism during mECS in animals (19,20) and humans (19,21,22) and generalized c-fos mRNA increase after mECS (23).…”

Section: Mapping Of Brain Activation During Electroshock-induced Seizsupporting

confidence: 93%

Dynamic Variations of Local Cerebral Blood Flow in Maximal Electroshock Seizures in the Rat

2002

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Summary:Purpose: Measurement of cerebral blood flow is routinely used to locate the areas involved in generation and spread of seizures in epilepsy patients. Because the nature of the hyperperfused regions varies with the timing of injection of tracer, in this study, we used a rat model of maximal electroshock seizures to follow up the time-dependent changes in the distribution of seizure-induced cerebral blood flow (CBF) changes.Methods: CBF was measured by the quantitative autoradiographic [ 14 C]iodoantipyrine technique over a 30-s duration. The tracer was injected either at 15 s before seizure induction, simultaneous with the application of the electroshock (tonic phase), at the onset of the clonic phase, or at 3 and 6 min after the seizure (postictal phase).Results: Rates of CBF underwent dynamic changes during the different phases of seizure activity and largely increased over control levels (Յ400%) in the 45 regions studied during all phases of the seizure (first 3 times). CBF remained higher than control levels in 35 and 15 areas at 3 and 6 min after the seizure, respectively.Conclusions: The distribution of maximal CBF increases showed a good correlation with their known involvement in the circuits underlying the clinical expression of the different types of seizure activity, tonic versus clonic. Key Words: Cerebral blood flow-[ 14 C]iodoantipyrine-Seizures-Electroshock.A number of patients with symptomatic or cryptogenic epilepsies are medically intractable and need the surgical resection of the epileptic focus (1-3). The success of surgery depends substantially on the validity of the data used for the location of the seizure focus (4,5). The methods available to localize the epileptic focus include seizure characterization; neurologic examination; neuropsychological testing; magnetic resonance imaging; functional brain imaging of blood flow with singlephoton emission computed tomography (SPECT) and of glucose utilization with positron emission tomography (PET); video/scalp electroencephalographic (EEG) recording; and video electrocorticography (ECoG) with depth, subdural, or epidural electrodes (6,7).Most epilepsy centers tend to perform less-invasive monitoring (8) and use quite routinely local cerebral blood flow (LCBF) measurement by SPECT with hexamethylpropylene amine oxime (HMPAO) or ethyl cysteinate dimer (ECD) labeled with 99m-technetium. Ictal SPECT shows increased LCBF in the epileptic focus in ∼95% of patients with temporal lobe epilepsy (4,5,9,10).However, there has been considerable discussion regarding the optimal timing of early postictal LCBF analysis (5,11,12) since the nature of the territories hyperperfused during the seizure varies with the timing of injection of the tracer. Thus the recognition of the dynamic process of ictal brain perfusion alteration is essential for the application of ictal/postictal SPECT LCBF measurement to localize the epileptic focus and the secondary spread of seizures.Therefore we used an animal model of seizures induced by maximal electroshock to observe...

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Section: Mapping Of Brain Activation During Electroshock-induced Seizsupporting

confidence: 93%

Dynamic Variations of Local Cerebral Blood Flow in Maximal Electroshock Seizures in the Rat

2002

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“…In our present study, although patients suffered mostly from chronic, recurrent depressions, retaining plasticity may still be important in achieving remission after a course of ECT. Moreover, compared to pre-ECT, post-ECT activity was shown to be increased in the mediotemporal lobe ( 31 – 33 ), and more specifically in the amygdala ( 34 ). At last, other studies showed relatively large mediotemporal lobe volumes ( 35 ) and high intra-amygdalar functional amino acids ( 36 ) specifically in patients that responded positively to ECT.…”

Section: Discussionmentioning

confidence: 98%

Pre-Treatment Amygdala Volume Predicts Electroconvulsive Therapy Response

et al. 2014

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Background: Electroconvulsive therapy (ECT) is an effective treatment for patients with severe depression. Knowledge on factors predicting therapeutic response may help to identify patients who will benefit most from the intervention. Based on the neuroplasticity hypothesis, volumes of the amygdala and hippocampus are possible candidates for predicting treatment outcome. Therefore, this prospective cohort study examines the predictive value of amygdala and hippocampal volumes for the effectiveness of ECT. Methods:Prior to ECT, 53 severely unipolar depressed patients [mean age 57 ± 14 years; 40% (n = 21) male] received structural magnetic resonance imaging (MRI) at 1.5T. Normalized amygdala and hippocampal volumes were calculated based on automatic segmentation by FreeSurfer (FS). Regression analyses were used to test if the normalized volumes could predict the response to a course of ECT based on the Montgomery-Åsberg Depression Rating Scale (MADRS) scores. Results:A larger amygdala volume independently and significantly predicted a lower post-ECT MADRS score (β = −0.347, P = 0.013).The left amygdala volume had greater predictive value for treatment outcome relative to the right amygdala volume. Hippocampal volume had no independent predictive value. Conclusion:A larger pre-treatment amygdala volume predicted more effective ECT, independent of other known predictors. Almost all patients continued their medication during the study, which might have influenced the course of treatment in ways that were not taken into account.

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“…Likewise, patients with major depression demonstrate blood flow abnormalities in these areas [25]. ECT has been shown to increase blood flow in broad cortical and subcortical areas in patients with either major depression [26] or chronic pain [27].…”

Section: Introductionmentioning

confidence: 99%