Lundsgaard Christoffer C, Gbyl Krzysztof, Videbech Poul
Center for Neuropsychiatric Depression Research, Mental Health Centre Glostrup, Denmark.
Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Acta Neuropsychiatr. 2023 Oct 16;37:e22. doi: 10.1017/neu.2023.48.
The cause of cognitive side effects after electroconvulsive therapy (ECT) is largely unknown. Alterations in the blood-brain barrier (BBB) have been considered in several recent ECT studies. We therefore found it worthwhile to perform a systematic review of the literature to examine if electrically induced seizures affect the permeability of the BBB.
PubMed/MEDLINE and Embase were searched 16 November 2022. Studies with a direct measurement of BBB permeability in animals treated with modified electroconvulsive stimulation (ECS) and in humans treated with ECT were included. Synthesis of results was narrative due to the low number of studies and differences in study designs.
Four animal and two human (31 participants) studies were included. In animals, two studies found increased BBB permeability to some smaller molecules after modified ECS, while the two other studies found marginally increased or unchanged permeability to albumin after treatment. In contrast, the human studies did not find increased BBB permeability to smaller molecules or albumin after ECT.
Animal but not human studies support increased BBB permeability to some smaller molecules after electrically induced seizures. However, this conclusion is confined by the low number of studies and the lack of studies applying state-of-the-art methods. More studies using modern approaches to measuring of BBB permeability are warranted.
The study was founded by (grant number 61151-05) and was registered on PROSPERO before data extraction was initiated (CRD42022331385).
电休克治疗（ECT）后认知副作用的原因在很大程度上尚不清楚。最近的几项ECT研究考虑了血脑屏障（BBB）的改变。因此，我们认为有必要对文献进行系统综述，以研究电诱发癫痫是否会影响血脑屏障的通透性。
于2022年11月16日检索了PubMed/MEDLINE和Embase。纳入了直接测量接受改良电惊厥刺激（ECS）治疗的动物和接受ECT治疗的人类血脑屏障通透性的研究。由于研究数量较少且研究设计存在差异，结果的综合采用叙述性方式。
纳入了四项动物研究和两项人类研究（31名参与者）。在动物研究中，两项研究发现改良ECS后血脑屏障对一些较小分子的通透性增加，而另外两项研究发现治疗后白蛋白的通透性略有增加或未改变。相比之下，人类研究未发现ECT后血脑屏障对较小分子或白蛋白的通透性增加。
动物研究而非人类研究支持电诱发癫痫后血脑屏障对一些较小分子的通透性增加。然而，这一结论受到研究数量少以及缺乏采用先进方法的研究的限制。有必要开展更多使用现代方法测量血脑屏障通透性的研究。
该研究由 （资助编号61151-05）资助，并在开始数据提取之前在PROSPERO上进行了注册（CRD42022331385）。
