Department of Psychiatry, University of Muenster, Germany.
Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milano, Italy.
Psychol Med. 2020 Apr;50(5):849-856. doi: 10.1017/S0033291719000758. Epub 2019 Apr 23.
Electroconvulsive therapy (ECT) is a fast-acting intervention for major depressive disorder. Previous studies indicated neurotrophic effects following ECT that might contribute to changes in white matter brain structure. We investigated the influence of ECT in a non-randomized prospective study focusing on white matter changes over time.
Twenty-nine severely depressed patients receiving ECT in addition to inpatient treatment, 69 severely depressed patients with inpatient treatment (NON-ECT) and 52 healthy controls (HC) took part in a non-randomized prospective study. Participants were scanned twice, approximately 6 weeks apart, using diffusion tensor imaging, applying tract-based spatial statistics. Additional correlational analyses were conducted in the ECT subsample to investigate the effects of seizure duration and therapeutic response.
Mean diffusivity (MD) increased after ECT in the right hemisphere, which was an ECT-group-specific effect. Seizure duration was associated with decreased fractional anisotropy (FA) following ECT. Longitudinal changes in ECT were not associated with therapy response. However, within the ECT group only, baseline FA was positively and MD negatively associated with post-ECT symptomatology.
Our data suggest that ECT changes white matter integrity, possibly reflecting increased permeability of the blood-brain barrier, resulting in disturbed communication of fibers. Further, baseline diffusion metrics were associated with therapy response. Coherent fiber structure could be a prerequisite for a generalized seizure and inhibitory brain signaling necessary to successfully inhibit increased seizure activity.
电抽搐疗法（ECT）是一种治疗重度抑郁症的快速作用干预措施。先前的研究表明 ECT 后具有神经营养作用，这可能有助于改变大脑白质结构。我们通过一项非随机前瞻性研究，专注于随时间推移的白质变化，调查了 ECT 的影响。
29 名接受 ECT 加住院治疗的重度抑郁症患者、69 名仅接受住院治疗的重度抑郁症患者（非 ECT 组）和 52 名健康对照者（HC）参加了一项非随机前瞻性研究。参与者使用弥散张量成像，应用基于束的空间统计学，在大约 6 周的时间内两次扫描。在 ECT 亚组中进行了额外的相关性分析，以调查癫痫持续时间和治疗反应的影响。
ECT 后右侧大脑半球的平均弥散度（MD）增加，这是 ECT 组特有的效应。癫痫持续时间与 ECT 后各向异性分数（FA）的降低有关。ECT 的纵向变化与治疗反应无关。然而，仅在 ECT 组中，基线 FA 与 ECT 后症状呈正相关，MD 与 ECT 后症状呈负相关。
我们的数据表明，ECT 改变了白质的完整性，可能反映了血脑屏障通透性的增加，导致纤维之间的通讯受到干扰。此外，基线扩散指标与治疗反应相关。连贯的纤维结构可能是全身性癫痫的先决条件，也是抑制过度癫痫活动所必需的抑制性脑信号。
