Institute of Mental Health, Suzhou Psychiatric Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, Jiangsu, 215137, China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200030, China.
Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200030, China.
Brain Stimul. 2019 Mar-Apr;12(2):319-328. doi: 10.1016/j.brs.2018.11.006. Epub 2018 Nov 17.
Electroconvulsive therapy (ECT) is often considered as an augmentation of antipsychotic treatment for schizophrenia in drug-refractory cases. However, the mechanisms underlying the observed therapeutic effects are still not understood.
We aimed to investigate changes in whole brain grey matter volume (GMV) before and after modified ECT. GMV was determined using voxel-based morphometry (VBM) whole brain analysis. Correlations of brain structural changes with clinical improvement were also investigated.
Twenty-one schizophrenia patients treated with a full course of ECT combined with antipsychotics (ECT group) and 21 schizophrenia patients treated only with antipsychotics (Drug group) were observed in parallel. Magnetic resonance imaging scans were performed at baseline (T1) and follow-up (T2) for each patient. Data were compared to a healthy control group (HC group) of 23 persons who were only scanned at baseline. Demographic data were matched between the three groups.
Significant interactions of group by time were found within four brain regions: the left parahippocampal gyrus/hippocampus, right parahippocampal gyrus/hippocampus, right temporal_pole_mid/superior temporal gyrus, and right insula. Post-hoc analysis revealed an increase of GMV across all four regions amongst ECT group, but a decrease of GMV within the Drug group. Furthermore, the ECT group showed a significant positive correlation of GMV change in the right parahippocampal gyrus/hippocampus with a reduction of positive subscore in the positive and negative syndrome scale. Both treatment groups did not differ significantly in terms of GMV from the HC group in these regions either at T1 or at T2.
Our findings indicate that ECT may induce brain plasticity as indexed by grey matter volume change during the treatment of schizophrenia via distinct mechanics from those by antipsychotic medications. ECT may ameliorate the positive psychotic symptoms of patients suffering from schizophrenia by preferentially targeting limbic brain areas such as the parahippocampal gyrus/hippocampus.
电抽搐治疗（ECT）常被认为是精神分裂症药物难治患者抗精神病治疗的一种增效手段。然而，观察到的治疗效果的机制仍不清楚。
我们旨在研究改良 ECT 前后全脑灰质体积（GMV）的变化。GMV 通过基于体素的形态测量学（VBM）全脑分析确定。还研究了脑结构变化与临床改善的相关性。
平行观察 21 例接受全疗程 ECT 联合抗精神病药物治疗的精神分裂症患者（ECT 组）和 21 例仅接受抗精神病药物治疗的精神分裂症患者（药物组）。每位患者在基线（T1）和随访（T2）时进行磁共振成像扫描。数据与仅在基线扫描的 23 名健康对照组（HC 组）进行比较。三组的人口统计学数据相匹配。
在四个脑区发现了组间时间的显著相互作用：左侧海马旁回/海马体、右侧海马旁回/海马体、右侧颞极中/上颞叶和右侧岛叶。事后分析显示，ECT 组所有四个区域的 GMV 均增加，而药物组 GMV 减少。此外，ECT 组右侧海马旁回/海马体 GMV 变化与阳性和阴性症状量表阳性评分降低呈显著正相关。在这些区域，无论是在 T1 还是 T2，ECT 组和药物组的 GMV 均与 HC 组无显著差异。
我们的发现表明，ECT 可能通过不同于抗精神病药物的机制，通过灰质体积变化诱导脑可塑性，从而改善精神分裂症患者的阳性精神病症状。ECT 可能通过优先靶向边缘脑区，如海马旁回/海马体，改善精神分裂症患者的阳性症状。
