Penttilä Jani, Paillère-Martinot Marie-Laure, Martinot Jean-Luc, Ringuenet Damien, Wessa Michèle, Houenou Josselin, Gallarda Thierry, Bellivier Frank, Galinowski André, Bruguière Pascale, Pinabel François, Leboyer Marion, Olié Jean-Pierre, Duchesnay Edouard, Artiges Eric, Mangin Jean-François, Cachia Arnaud
INSERM, U797 Research Unit Neuroimaging & Psychiatry, CEA, Hospital Department Frédéric Joliot & Neurospin, Paris Sud University, Orsay, France.
J Psychiatry Neurosci. 2009 Mar;34(2):127-35.
Analysis of cortical folding may provide insight into neurodevelopment deviations, which, in turn, can predispose to depression that responds particularly poorly to medications. We hypothesized that patients with treatment-resistant depression would exhibit measurable alterations in cortical folding.
We computed hemispheric global sulcal indices (g-SIs) in T(1)-weighted magnetic resonance images obtained from 76 patients and 70 healthy controls. We separately searched for anatomic deviations in patients with bipolar disorder (16 patients with treatment-resistant depression, 25 with euthymia) and unipolar depression (35 patients with treatment-resistant depression).
Compared with healthy controls, both groups of patients with treatment-resistant depression exhibited reduced g-SIs: in the right hemisphere among patients with bipolar disorder and in both hemispheres among those with unipolar depression. Patients with euthymic bipolar disorder did not differ significantly from depressed patients or healthy controls. Among patients with bipolar disorder who were taking lithium, we found positive correlations between current lithium dose and g-SIs in both hemispheres.
We cannot estimate the extent to which the observed g-SI reductions are linked to treatment resistance and to what extent they are state-dependent. Furthermore, we cannot disentangle the impact of medications from that of the affective disorder. Finally, there is interindividual variation and overlap of g-SIs among patients and healthy controls that need to be considered when interpreting our results.
Reduced global cortical folding surface appears to be characteristic of patients with treatment-resistant depression, either unipolar or bipolar. In patients with bipolar disorder, treatment with lithium may modify cortical folding surface.
对皮质折叠的分析可能有助于深入了解神经发育偏差，而神经发育偏差反过来又可能导致对药物反应特别差的抑郁症。我们假设，难治性抑郁症患者的皮质折叠会出现可测量的改变。
我们计算了从76例患者和70名健康对照者获得的T(1)加权磁共振图像中的半球全局沟指数（g-SIs）。我们分别在双相情感障碍患者（16例难治性抑郁症患者，25例心境正常者）和单相抑郁症患者（35例难治性抑郁症患者）中寻找解剖学偏差。
与健康对照者相比，两组难治性抑郁症患者的g-SIs均降低：双相情感障碍患者右侧半球以及单相抑郁症患者双侧半球。心境正常的双相情感障碍患者与抑郁症患者或健康对照者之间无显著差异。在服用锂盐的双相情感障碍患者中，我们发现当前锂盐剂量与双侧半球的g-SIs呈正相关。
我们无法估计观察到的g-SI降低与治疗抵抗的关联程度以及与状态相关的程度。此外，我们无法区分药物的影响和情感障碍的影响。最后，在解释我们的结果时，需要考虑患者和健康对照者之间g-SIs的个体差异和重叠。
无论是单相还是双相难治性抑郁症患者，其整体皮质折叠表面减少似乎是其特征。在双相情感障碍患者中，锂盐治疗可能会改变皮质折叠表面。
