Loef Dore, Argyelan Miklos, Ruhé Henricus G, Scheepens Dominique S, Schoevers Robert A, Tendolkar Indira, van Exel Eric, van Waarde Jeroen A, van Wingen Guido A, Verdijk Joey P A J, Verwijk Esmée, Dols Annemiek, van Eijndhoven Philip F P
Department of Psychiatry, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, The Netherlands.
Neuropsychopharmacology. 2025 Jun;50(7):1102-1118. doi: 10.1038/s41386-024-02050-7. Epub 2025 Jan 6.
Electroconvulsive therapy (ECT) is an effective treatment for depression but is often associated with cognitive side effects. In patients, ECT-induced electric field (E-field) strength across brain regions varies significantly due to anatomical differences, which may explain individual differences in cognitive side effects. We examined the relationship between regional E-field strength and change in verbal fluency score (i.e., category fluency animals score from pre- to 1 week post-ECT; as key proxy of cognitive side effects) across different electrode placements in depressed patients. Secondary, we examined the relationship between regional E-field strength and depression outcome. Using T1 magnetic resonance imaging, we performed E-field modeling in a total of 109 patients. Linear mixed models were executed to analyze the relationship between E-field strength across all 118 brain regions and both cognitive and depression outcomes, while correcting for nuisance variables (e.g., age, total number of ECT sessions, and study cohort). We found that a higher E-field strength was significantly associated with a higher decline in verbal fluency (n = 71, false discovery rate [FDR] corrected p < 0.01) in several brain regions in the left hemisphere (e.g., temporal gyrus and operculum cortex). Moreover, numerous significant associations were found only in the 24 patients treated with right unilateral ECT. No significant relationships were found between regional E-field strength and depression outcome. In conclusion, significant associations between verbal fluency and E-field strength were found in areas crucial for linguistic processing and semantic memory. Our findings underscore the importance of considering individualized dosing strategies to optimize cognitive outcome in ECT, while maintaining its antidepressant efficacy.
电休克疗法（ECT）是治疗抑郁症的一种有效方法，但常常伴有认知方面的副作用。在患者中，由于解剖结构差异，ECT在大脑各区域诱发的电场（E场）强度差异显著，这可能解释了认知副作用的个体差异。我们研究了抑郁症患者不同电极位置下区域E场强度与言语流畅性得分变化（即ECT前至ECT后1周的动物类别流畅性得分；作为认知副作用的关键指标）之间的关系。其次，我们研究了区域E场强度与抑郁治疗结果之间的关系。利用T1磁共振成像，我们对总共109名患者进行了E场建模。执行线性混合模型来分析所有118个脑区的E场强度与认知和抑郁治疗结果之间的关系，同时校正干扰变量（如年龄、ECT治疗总次数和研究队列）。我们发现，较高的E场强度与左半球几个脑区（如颞叶回和岛盖皮质）言语流畅性的更大下降显著相关（n = 71，错误发现率[FDR]校正p < 0.01）。此外，仅在24例接受右侧单侧ECT治疗的患者中发现了许多显著关联。未发现区域E场强度与抑郁治疗结果之间存在显著关系。总之，在对语言处理和语义记忆至关重要的区域发现了言语流畅性与E场强度之间的显著关联。我们的研究结果强调了在维持ECT抗抑郁疗效的同时，考虑个体化给药策略以优化认知治疗结果的重要性。
