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Comparison of electric field strength and spatial distribution of electroconvulsive therapy and magnetic seizure therapy in a realistic human head model

Published online by Cambridge University Press:  23 March 2020

W.H. Lee ,
S.H. Lisanby ,
A.F. Laine  and
A.V. Peterchev
W.H. Lee
Affiliation:
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY10029, USA
S.H. Lisanby
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC27710, USA Department of Psychology & Neuroscience, Duke University, Durham, NC27708, USA Department of Psychiatry, Columbia University, New York, NY10032, USA National Institute of Mental Health, National Institutes of Health, Bethesda, MD20892, USA
A.F. Laine
Affiliation:
Department of Biomedical Engineering, Columbia University, New York, NY10027, USA
A.V. Peterchev*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC27710, USA Department of Biomedical Engineering, Duke University, Durham, NC27708, USA Department of Electrical and Computer Engineering, Duke University, Durham, NC27708, USA
*
⁎Corresponding author. Department of Psychiatry and Behavioral Sciences, Duke University, Box 3620, DUMC, Durham, NC 27710, USA. Tel.: +1 919 684 0383; fax: +1 919 681 9962. [email protected]
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Abstract

Background

This study examines the strength and spatial distribution of the electric field induced in the brain by electroconvulsive therapy (ECT) and magnetic seizure therapy (MST).

Methods

The electric field induced by standard (bilateral, right unilateral, and bifrontal) and experimental (focal electrically administered seizure therapy and frontomedial) ECT electrode configurations as well as a circular MST coil configuration was simulated in an anatomically realistic finite element model of the human head. Maps of the electric field strength relative to an estimated neural activation threshold were used to evaluate the stimulation strength and focality in specific brain regions of interest for these ECT and MST paradigms and various stimulus current amplitudes.

Results

The standard ECT configurations and current amplitude of 800–900 mA produced the strongest overall stimulation with median of 1.8–2.9 times neural activation threshold and more than 94% of the brain volume stimulated at suprathreshold level. All standard ECT electrode placements exposed the hippocampi to suprathreshold electric field, although there were differences across modalities with bilateral and right unilateral producing respectively the strongest and weakest hippocampal stimulation. MST stimulation is up to 9 times weaker compared to conventional ECT, resulting in direct activation of only 21% of the brain. Reducing the stimulus current amplitude can make ECT as focal as MST.

Conclusions

The relative differences in electric field strength may be a contributing factor for the cognitive sparing observed with right unilateral compared to bilateral ECT, and MST compared to right unilateral ECT. These simulations could help understand the mechanisms of seizure therapies and develop interventions with superior risk/benefit ratio.

Keywords

Unipolar depressionMania and bipolar disorderMRIECTTranscranial magnetic stimulation (TMS)
Type
Original article
Information
European Psychiatry , Volume 36 , August 2016 , pp. 55 - 64
Copyright
Copyright © European Psychiatric Association 2016

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