Kafashan MohammadMehdi, Lebovitz Lucas, Greenspan Robby, Zhao Sijia, Kim Tae, Husain Masud, Hershey Tamara, Cristancho Pilar, Hogan R Edward, Palanca Ben Julian Agustin, Farber Nuri B
Department of Anesthesiology, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA
Center on Biological Rhythms and Sleep, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA.
BMJ Open. 2025 Mar 7;15(3):e098859. doi: 10.1136/bmjopen-2025-098859.
Electroconvulsive therapy (ECT) is a highly effective treatment for refractory depression, but it may also cause cognitive side effects. Despite decades of use, the mechanisms by which ECT exerts both its antidepressant and cognitive effects are still poorly understood, with the latter substantially limiting referral and adherence to therapy. ECT induces changes in correlated neural activity-functional connectivity-across various brain networks, which may underlie both its clinical efficacy and associated cognitive side effects. Electroencephalography (EEG) could address these knowledge gaps by identifying biomarkers that predict therapeutic outcomes or cognitive side effects. Such developments could ultimately improve patient selection and adherence. Such markers likely span large-scale functional brain networks or temporal dynamics of brain activity during sleep. We hypothesise that enhancement in slow wave sleep mediates the relationship between antidepressant effects and changes in functional connectivity throughout the course of ECT.
Disruptions of Brain Networks and Sleep by Electroconvulsive Therapy (DNS-ECT) is an ongoing observational study investigating the impact of ECT on large-scale brain functional networks and their relationships to sleep slow waves, an EEG marker linked to synaptic plasticity. The novelty of this study stems from our focus on the assessment of EEG markers during sleep, wakefulness and ECT-induced seizures over the course of therapy. Graph-based network analyses of high-density EEG signals allow characterisation of functional networks locally in specific subnetworks and globally over large-scale functional networks. Longitudinal assessments of EEG alongside clinical and cognitive outcomes provide a unique opportunity to improve our understanding of the circuit mechanisms underlying the development of cognitive impairments and antidepressant effects incurred during ECT.
Recruitment for this 5-year study started in March 2023. Dissemination plans include presentations at scientific conferences and peer-reviewed publications. This study has been registered with ClinicalTrials.gov registry under identifier.
NCT05905705.
电休克疗法（ECT）是治疗难治性抑郁症的一种高效疗法，但它也可能引发认知方面的副作用。尽管已应用数十年，ECT发挥其抗抑郁和认知作用的机制仍未得到充分理解，认知副作用严重限制了该疗法的转诊和患者依从性。ECT会引起不同脑网络间相关神经活动——功能连接性——的变化，这可能是其临床疗效及相关认知副作用的基础。脑电图（EEG）可通过识别预测治疗结果或认知副作用的生物标志物来填补这些知识空白。此类进展最终可能改善患者的选择和依从性。这些标志物可能涉及大规模功能性脑网络或睡眠期间脑活动的时间动态变化。我们假设慢波睡眠的增强介导了ECT治疗过程中抗抑郁作用与功能连接性变化之间的关系。
电休克疗法对脑网络和睡眠的破坏（DNS-ECT）是一项正在进行的观察性研究，旨在探究ECT对大规模脑功能网络的影响及其与睡眠慢波的关系，睡眠慢波是一种与突触可塑性相关的EEG标志物。本研究的新颖之处在于我们专注于在治疗过程中评估睡眠、清醒和ECT诱发癫痫发作期间的EEG标志物。基于图的高密度EEG信号网络分析能够在特定子网络局部以及大规模功能网络全局对功能网络进行特征描述。EEG与临床和认知结果的纵向评估为增进我们对ECT期间发生的认知障碍和抗抑郁作用发展背后的电路机制的理解提供了独特机会。
这项为期5年的研究于2023年3月开始招募受试者。传播计划包括在科学会议上发表演讲和在同行评审期刊上发表文章。本研究已在ClinicalTrials.gov注册中心注册，注册号为：
NCT05905705。
