Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.
J Neurosci Res. 2022 Feb;100(2):477-489. doi: 10.1002/jnr.24979. Epub 2021 Nov 25.
Approximately two-thirds of major depressive disorder (MDD) patients have pain, which exacerbates the severity of depression. Electroconvulsive therapy (ECT) is an efficacious treatment that can alleviate depressive symptoms; however, treatment for pain and the underlying neural substrate is elusive. We enrolled 34 patients with MDD and 33 matched healthy controls to complete clinical assessments and neuroimaging scans. MDD patients underwent second assessments and scans after ECT. We defined a pain-related network with a published meta-analysis and calculated topological patterns to reveal topologic alterations induced by ECT. Using the amplitude of low-frequency fluctuations (ALFFs), we probed local function aberrations of pain-related circuits in MDD patients. Subsequently, we applied gray matter volume (GMV) to reveal structural alterations of ECT relieving pain. The relationships between functional and structural aberrations and pain were determined. ECT significantly alleviated pain. The neural mechanism based on pain-related circuits indicated that ECT weakened the circuit function (ALFF: left amygdala and right supplementary motor area), while augmenting the structure (GMV: bilateral amygdala/insula/hippocampus and anterior cingulate cortex). The topologic patterns became less efficient after ECT. Correlation analysis between the change in pain and GMV had negative results in bilateral amygdala/insula/hippocampus. Similarity, there was a positive correlation between a change in ALFF in the left amygdala and improved clinical symptoms. ECT improved pain by decreasing brain local function and global network patterns, while increasing structure in pain-related circuits. Functional and structural alterations were associated with improvement in pain.
大约三分之二的重度抑郁症（MDD）患者有疼痛，这会加重抑郁的严重程度。电抽搐疗法（ECT）是一种有效的治疗方法，可以缓解抑郁症状；然而，针对疼痛和潜在神经基础的治疗方法仍难以捉摸。我们招募了 34 名 MDD 患者和 33 名匹配的健康对照组，以完成临床评估和神经影像学扫描。MDD 患者在 ECT 后进行了第二次评估和扫描。我们使用已发表的荟萃分析定义了一个与疼痛相关的网络，并计算了拓扑模式，以揭示 ECT 引起的拓扑改变。我们使用低频振幅（ALFF）来探测 MDD 患者疼痛相关回路的局部功能异常。随后，我们应用灰质体积（GMV）来揭示 ECT 缓解疼痛的结构改变。确定了功能和结构异常与疼痛之间的关系。ECT 显著缓解了疼痛。基于疼痛相关回路的神经机制表明，ECT 减弱了回路功能（ALFF：左杏仁核和右辅助运动区），同时增强了结构（GMV：双侧杏仁核/岛叶/海马体和前扣带皮层）。ECT 后拓扑模式变得效率降低。疼痛变化与 GMV 之间的相关性分析在双侧杏仁核/岛叶/海马体中结果为负。类似地，左杏仁核 ALFF 的变化与临床症状的改善呈正相关。ECT 通过降低大脑局部功能和全局网络模式来改善疼痛，同时增加疼痛相关回路的结构。功能和结构的改变与疼痛的改善有关。
