Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Strasse 5, 37075, Göttingen, Germany.
German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany.
Eur Arch Psychiatry Clin Neurosci. 2024 Aug;274(5):1187-1195. doi: 10.1007/s00406-023-01686-8. Epub 2023 Sep 1.
Electroconvulsive therapy (ECT) is an effective, safe, and mostly well-tolerated treatment for patients with severe or difficult to treat depression or psychotic disorders. However, a relevant number of patients experience subjective and/or objective cognitive side-effects. The mechanism of these transient deficits is not yet clear. Thus, our study prospectively investigated neurofilament light chain (NfL) concentrations as a highly sensitive biomarker for neuroaxonal damage along with cognitive performance during a course of ECT. Serum NfL concentrations from 15 patients with major depressive disorder receiving ECT were analyzed (1) 24 h before the first ECT, (2) 24 h and (3) 7 days after the last ECT (45 measurements in total). Neuropsychological testing including memory, executive functions and attention was performed at each time-point. NfL concentrations did not change between the three time-points, while a temporary cognitive impairment was found. Even in the subset of patients with the strongest impairment, NfL concentrations remained unchanged. Neuropsychological testing revealed the common pattern of transient cognitive side-effects with reduced performance 24 h post-ECT (global cognition score: p < 0.001; memory: p = 0.043; executive functions: p = 0.002) and return to baseline after 7 days (all p < 0.001). Our study adds to the evidence that neither ECT per se nor the transient cognitive side-effects seem to be associated with an increase of NfL as a marker of neuroaxonal damage. In contrast, we discuss cognitive side effects to be potentially interpreted as a byproduct of ECT's neuroplastic effects.
电抽搐治疗（ECT）是一种有效、安全且大多能耐受的治疗严重或难以治疗的抑郁症或精神病性障碍的方法。然而，相当数量的患者经历主观和/或客观的认知副作用。这些短暂缺陷的机制尚不清楚。因此，我们的研究前瞻性地调查了神经丝轻链（NfL）浓度作为神经轴突损伤的高度敏感生物标志物，以及 ECT 过程中的认知表现。分析了 15 名接受 ECT 的重性抑郁症患者的血清 NfL 浓度（1）在第一次 ECT 前 24 小时，（2）在最后一次 ECT 后 24 小时和（3）第 7 天（总共 45 次测量）。在每个时间点进行包括记忆、执行功能和注意力在内的神经心理学测试。NfL 浓度在三个时间点之间没有变化，而认知功能暂时受损。即使在认知功能损害最强的患者亚组中，NfL 浓度也保持不变。神经心理学测试显示出短暂认知副作用的常见模式，ECT 后 24 小时（整体认知评分：p<0.001；记忆：p=0.043；执行功能：p=0.002）表现下降，7 天后恢复基线（所有 p<0.001）。我们的研究增加了证据表明，ECT 本身或短暂的认知副作用似乎都不会导致 NfL 增加作为神经轴突损伤的标志物。相反，我们认为认知副作用可能被解释为 ECT 神经可塑性效应的副产品。
