Department of Psychiatry, University of Occupational and Environmental Health, Kitakyushu, Japan.
Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Affect Disord. 2023 Nov 1;340:923-929. doi: 10.1016/j.jad.2023.08.020. Epub 2023 Aug 19.
To investigate the effect of electroconvulsive treatment (ECT) on dynamic structural network connectivity in major depressive disorder (MDD), based on the triple-network model.
Twenty-one first-episode, drug-naïve patients with MDD and 21 age- and sex-matched healthy subjects were recruited. Bilateral electrical stimulation was performed thrice a week for a total of 4-5 weeks in the MDD group. MRI data were obtained, and triple-network structural connectivity was evaluated using source-based morphometry (SBM) analysis. A paired t-test was used to analyze structural connectivity differences between pre- and post-ECT MDD groups, one-way analysis was used to calculate three intrinsic network differences between HCs, pre- and post-ECT groups, and partial least squares structural equation modelling was used to investigate dynamic structural network connectivity (dSNC) across groups.
Pre-ECT patients with MDD exhibited significantly lower salience network (SN) structural connectivity (p = 0.010) than the healthy control (HC) group and after ECT therapy SN structural connectivity was significantly elevated (p = 0.002) in post-ECT group compared with pre-ECT. PLS-SEM analysis conducted on inter-network connectivity in the triple-network model indicated a significant difference between SN and central executive network (CEN) in all three groups. The HC and post-ECT MDD groups showed notable direct connectivity between the SN and default mode network (DMN), while the pre-ECT MDD group showed consequential pathological connectivity between the CEN and DMN. A mediation analysis revealed a significant indirect effect of the SN on the DMN through the CEN (β = 0.363, p = 0.008) only in the pre-ECT MDD group.
ECT may be an effective and minimally invasive treatment for addressing structural changes in the SN and direct communication abnormalities between the three core brain networks in patients with MDD, with possible beneficial correction of indirect connections.
基于三重网络模型，探讨电休克治疗（ECT）对重性抑郁障碍（MDD）动态结构网络连通性的影响。
招募 21 例首发、未经药物治疗的 MDD 患者和 21 名年龄和性别匹配的健康对照者。MDD 组每周进行 3 次双侧电刺激，共 4-5 周。获得 MRI 数据，并使用基于源的形态测量法（SBM）分析评估三重网络结构连通性。采用配对 t 检验分析 MDD 组 ECT 前后结构连通性差异，采用单向方差分析计算健康对照组、ECT 前组和 ECT 后组三个固有网络差异，采用偏最小二乘结构方程模型（PLS-SEM）研究组间动态结构网络连通性（dSNC）。
ECT 前 MDD 患者的显着低于健康对照组（HC）的显着低于健康对照组（HC）（p = 0.010），ECT 后 MDD 患者的显着低于健康对照组（HC）（p = 0.002）。在三重网络模型中对网络间连通性进行 PLS-SEM 分析表明，在所有三组中，SN 和中枢执行网络（CEN）之间存在显着差异。HC 和 ECT 后 MDD 组显示 SN 和默认模式网络（DMN）之间存在明显的直接连通性，而 ECT 前 MDD 组显示 CEN 和 DMN 之间存在继发的病理性连通性。中介分析显示，只有在 ECT 前 MDD 组中，SN 通过 CEN 对 DMN 存在显着的间接影响（β=0.363，p=0.008）。
ECT 可能是一种有效且微创的治疗方法，可改善 MDD 患者 SN 的结构变化，并改善三个核心脑网络之间的直接通讯异常，可能对间接连接有有益的纠正。
