Resident, Department of Psychiatry and Psychotherapy,Medical University of Vienna,Austria.
Consultant Psychiatrist, Department of Psychiatry and Psychotherapy,Medical University of Vienna,Austria.
Br J Psychiatry. 2019 Mar;214(3):159-167. doi: 10.1192/bjp.2018.224. Epub 2018 Nov 16.
Electroconvulsive therapy (ECT) is the treatment of choice for severe mental illness including treatment-resistant depression (TRD). Increases in volume of the hippocampus and amygdala following ECT have consistently been reported.AimsTo investigate neuroplastic changes after ECT in specific hippocampal subfields and amygdala nuclei using high-resolution structural magnetic resonance imaging (MRI) (trial registration: clinicaltrials.gov - NCT02379767).
MRI scans were carried out in 14 patients (11 women, 46.9 years (s.d. = 8.1)) with unipolar TRD twice before and once after a series of right unilateral ECT in a pre-post study design. Volumes of subcortical structures, including subfields of the hippocampus and amygdala, and cortical thickness were extracted using FreeSurfer. The effect of ECT was tested using repeated-measures ANOVA. Correlations of imaging and clinical parameters were explored.
Increases in volume of the right hippocampus by 139.4 mm3 (s.d. = 34.9), right amygdala by 82.3 mm3 (s.d. = 43.9) and right putamen by 73.9 mm3 (s.d. = 77.0) were observed. These changes were localised in the basal and lateral nuclei, and the corticoamygdaloid transition area of the amygdala, the hippocampal-amygdaloid transition area and the granule cell and molecular layer of the dentate gyrus. Cortical thickness increased in the temporal, parietal and insular cortices of the right hemisphere.
Following ECT structural changes were observed in hippocampal subfields and amygdala nuclei that are specifically implicated in the pathophysiology of depression and stress-related disorders and retain a high potential for neuroplasticity in adulthood.Declaration of interestS.K. has received grants/research support, consulting fees and/or honoraria within the past 3 years from Angelini, AOP Orphan Pharmaceuticals AG, AstraZeneca, Celegne GmbH, Eli Lilly, Janssen-Cilag Pharma GmbH, KRKA-Pharma, Lundbeck A/S, Neuraxpharm, Pfizer, Pierre Fabre, Schwabe and Servier. R.L. received travel grants and/or conference speaker honoraria from Shire, AstraZeneca, Lundbeck A/S, Dr. Willmar Schwabe GmbH, Orphan Pharmaceuticals AG, Janssen-Cilag Pharma GmbH, and Roche Austria GmbH.
电痉挛疗法（ECT）是治疗严重精神疾病的首选方法，包括治疗抵抗性抑郁症（TRD）。ECT 后海马体和杏仁核体积增加的情况一直有报道。目的：使用高分辨率结构磁共振成像（MRI）（临床试验注册：clinicaltrials.gov - NCT02379767）研究 ECT 后特定海马亚区和杏仁核核团的神经可塑性变化。方法：采用 MRI 对 14 例（11 名女性，46.9 岁（标准差=8.1））单侧 TRD 患者进行研究，这些患者在双侧 ECT 前和后进行了两次预-后研究设计的 MRI 扫描。使用 FreeSurfer 提取皮质下结构（包括海马亚区和杏仁核）和皮质厚度的体积。使用重复测量方差分析测试 ECT 的效果。探索了影像学和临床参数的相关性。结果：观察到右侧海马体体积增加了 139.4mm3（标准差=34.9），右侧杏仁核体积增加了 82.3mm3（标准差=43.9），右侧壳核体积增加了 73.9mm3（标准差=77.0）。这些变化局限于基底核和外侧核，以及杏仁核的皮质-杏仁核过渡区、海马-杏仁核过渡区和齿状回的颗粒细胞和分子层。右侧颞叶、顶叶和岛叶皮质的皮质厚度增加。结论：ECT 后观察到海马亚区和杏仁核核团的结构变化，这些变化与抑郁和应激相关障碍的病理生理学密切相关，并且在成年后仍具有高度的神经可塑性。利益声明 S.K. 在过去 3 年内收到了 Angelini、AOP Orphan Pharmaceuticals AG、AstraZeneca、Celegne GmbH、Eli Lilly、Janssen-Cilag Pharma GmbH、KRKA-Pharma、Lundbeck A/S、Neuraxpharm、Pfizer、Pierre Fabre、Schwabe 和 Servier 的资助/研究支持、咨询费和/或酬金。R.L. 曾获得 Shire、AstraZeneca、Lundbeck A/S、Dr. Willmar Schwabe GmbH、Orphan Pharmaceuticals AG、Janssen-Cilag Pharma GmbH 和 Roche Austria GmbH 的旅行资助和/或会议演讲酬金。
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