Fronto-medial Electrode Placement for Electroconvulsive Treatment of Depression

Overview

Journal Front Neurosci

Date 2022 Nov 7

PMID 36340770

Authors

J Douglas Steele

Tom Farnan

David M Semple

Siwei Bai

Affiliations

Soon will be listed here.

Abstract

Electroconvulsive therapy (ECT) is the most effective treatment for severe treatment-resistant depression but concern about cognitive side-effects, particularly memory loss, limits its use. Recent observational studies on large groups of patients who have received ECT report that cognitive side-effects were associated with electric field (EF) induced increases in hippocampal volume, whereas therapeutic efficacy was associated with EF induced increases in sagittal brain structures. The aim in the present study was to determine whether a novel fronto-medial (FM) ECT electrode placement would minimize electric fields in bilateral hippocampi (HIP) whilst maximizing electric fields in dorsal sagittal cortical regions. An anatomically detailed computational head model was used with finite element analysis, to calculate ECT-induced electric fields in specific brain regions identified by translational neuroimaging studies of treatment-resistant depressive illness, for a range of electrode placements. As hypothesized, compared to traditional bitemporal (BT) electrode placement, a specific FM electrode placement reduced bilateral hippocampal electric fields two-to-three-fold, whilst the electric fields in the dorsal anterior cingulate (dAC) were increased by approximately the same amount. We highlight the clinical relevance of this specific FM electrode placement for ECT, which may significantly reduce cognitive and non-cognitive side-effects and suggest a clinical trial is indicated.

References

Whiteford H, Degenhardt L, Rehm J, Baxter A, Ferrari A, Erskine H . Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet. 2013; 382(9904):1575-86. DOI: 10.1016/S0140-6736(13)61611-6. View

Anderson I, McAllister-Williams R, Downey D, Elliott R, Loo C . Cognitive function after electroconvulsive therapy for depression: relationship to clinical response. Psychol Med. 2020; 51(10):1647-1656. PMC: 8327625. DOI: 10.1017/S0033291720000379. View

Haghighi M, Sedighinejad A, Nabi B, Emiralavi C, Biazar G, Mirmozaffari K . The Incidence and Predictors of Headache and Myalgia in Patients After Electroconvulsive Therapy (ECT). Anesth Pain Med. 2016; 6(3):e33724. PMC: 5055710. DOI: 10.5812/aapm.33724. View

Rupprechter S, Romaniuk L, Series P, Hirose Y, Hawkins E, Sandu A . Blunted medial prefrontal cortico-limbic reward-related effective connectivity and depression. Brain. 2020; 143(6):1946-1956. PMC: 7296844. DOI: 10.1093/brain/awaa106. View

Mayberg H, Lozano A, Voon V, McNeely H, Seminowicz D, Hamani C . Deep brain stimulation for treatment-resistant depression. Neuron. 2005; 45(5):651-60. DOI: 10.1016/j.neuron.2005.02.014. View

Lee W, Lisanby S, Laine A, Peterchev A . Comparison of electric field strength and spatial distribution of electroconvulsive therapy and magnetic seizure therapy in a realistic human head model. Eur Psychiatry. 2016; 36:55-64. PMC: 5403008. DOI: 10.1016/j.eurpsy.2016.03.003. View

Malberg J, Hen R, Madsen T . Adult Neurogenesis and Antidepressant Treatment: The Surprise Finding by Ron Duman and the Field 20 Years Later. Biol Psychiatry. 2021; 90(2):96-101. DOI: 10.1016/j.biopsych.2021.01.010. View

Deng Z, Argyelan M, Miller J, Quinn D, Lloyd M, Jones T . Electroconvulsive therapy, electric field, neuroplasticity, and clinical outcomes. Mol Psychiatry. 2021; 27(3):1676-1682. PMC: 9095458. DOI: 10.1038/s41380-021-01380-y. View

Mulders P, Llera A, Beckmann C, Vandenbulcke M, Stek M, Sienaert P . Structural changes induced by electroconvulsive therapy are associated with clinical outcome. Brain Stimul. 2020; 13(3):696-704. DOI: 10.1016/j.brs.2020.02.020. View

10.

Holtzheimer P, Husain M, Lisanby S, Taylor S, Whitworth L, McClintock S . Subcallosal cingulate deep brain stimulation for treatment-resistant depression: a multisite, randomised, sham-controlled trial. Lancet Psychiatry. 2017; 4(11):839-849. DOI: 10.1016/S2215-0366(17)30371-1. View

11.

Deakin J . The origins of '5-HT and mechanisms of defence' by Deakin and Graeff: a personal perspective. J Psychopharmacol. 2013; 27(12):1084-9. DOI: 10.1177/0269881113503508. View

12.

Tolomeo S, Christmas D, Jentzsch I, Johnston B, Sprengelmeyer R, Matthews K . A causal role for the anterior mid-cingulate cortex in negative affect and cognitive control. Brain. 2016; 139(Pt 6):1844-54. DOI: 10.1093/brain/aww069. View

13.

Squire L . Mechanisms of memory. Science. 1986; 232(4758):1612-9. DOI: 10.1126/science.3086978. View

14.

Mayberg H, Liotti M, Brannan S, McGinnis S, Mahurin R, Jerabek P . Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatry. 1999; 156(5):675-82. DOI: 10.1176/ajp.156.5.675. View

15.

Mulder L, Grootens K . The Incidence of Post-Electroconvulsive Therapy Headache: A Systematic Review. J ECT. 2020; 36(3):e22-e28. DOI: 10.1097/YCT.0000000000000677. View

16.

Gbyl K, Stottrup M, Raghava J, Xue Jie S, Videbech P . Hippocampal volume and memory impairment after electroconvulsive therapy in patients with depression. Acta Psychiatr Scand. 2020; 143(3):238-252. DOI: 10.1111/acps.13259. View

17.

Peterchev A, Krystal A, Rosa M, Lisanby S . Individualized Low-Amplitude Seizure Therapy: Minimizing Current for Electroconvulsive Therapy and Magnetic Seizure Therapy. Neuropsychopharmacology. 2015; 40(9):2076-84. PMC: 4613599. DOI: 10.1038/npp.2015.122. View

18.

Perrin J, Merz S, Bennett D, Currie J, Steele D, Reid I . Electroconvulsive therapy reduces frontal cortical connectivity in severe depressive disorder. Proc Natl Acad Sci U S A. 2012; 109(14):5464-8. PMC: 3325678. DOI: 10.1073/pnas.1117206109. View

19.

Oltedal L, Narr K, Abbott C, Anand A, Argyelan M, Bartsch H . Volume of the Human Hippocampus and Clinical Response Following Electroconvulsive Therapy. Biol Psychiatry. 2018; 84(8):574-581. PMC: 6697556. DOI: 10.1016/j.biopsych.2018.05.017. View

20.

Cheng W, Rolls E, Qiu J, Yang D, Ruan H, Wei D . Functional Connectivity of the Precuneus in Unmedicated Patients With Depression. Biol Psychiatry Cogn Neurosci Neuroimaging. 2018; 3(12):1040-1049. DOI: 10.1016/j.bpsc.2018.07.008. View