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Computational models of Bitemporal, Bifrontal and Right Unilateral ECT predict differential stimulation of brain regions associated with efficacy and cognitive side effects

Published online by Cambridge University Press:  03 February 2017

S. Bai ,
V. Gálvez ,
S. Dokos ,
D. Martin ,
M. Bikson  and
C. Loo
S. Bai
Affiliation:
Department of Electrical and Computer Engineering, Technische Universität München, 80333München, Germany Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales (UNSW), NSW2052, Australia
V. Gálvez
Affiliation:
School of Psychiatry, UNSW, NSW2052, Australia Black Dog Institute, NSW, 2031, Australia
S. Dokos
Affiliation:
Graduate School of Biomedical Engineering, Faculty of Engineering, University of New South Wales (UNSW), NSW2052, Australia
D. Martin
Affiliation:
School of Psychiatry, UNSW, NSW2052, Australia Black Dog Institute, NSW, 2031, Australia
M. Bikson
Affiliation:
Department of Biomedical Engineering, The City College of The City University of New York, New York, USA
C. Loo*
Affiliation:
School of Psychiatry, UNSW, NSW2052, Australia Black Dog Institute, NSW, 2031, Australia Department of Psychiatry, St George Hospital, NSW2217, Australia
*
⁎Corresponding author at: Black Dog Institute, Hospital Road, Prince of Wales Hospital, Randwick, NSW 2031, Australia. Tel.: +61 2 9113 2039; fax: +61 2 9113 3734. E-mail address: [email protected] (C. Loo).
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Abstract

Background

Extensive clinical research has shown that the efficacy and cognitive outcomes of electroconvulsive therapy (ECT) are determined, in part, by the type of electrode placement used. Bitemporal ECT (BT, stimulating electrodes placed bilaterally in the frontotemporal region) is the form of ECT with relatively potent clinical and cognitive side effects. However, the reasons for this are poorly understood.

Objective

This study used computational modelling to examine regional differences in brain excitation between BT, Bifrontal (BF) and Right Unilateral (RUL) ECT, currently the most clinically-used ECT placements. Specifically, by comparing similarities and differences in current distribution patterns between BT ECT and the other two placements, the study aimed to create an explanatory model of critical brain sites that mediate antidepressant efficacy and sites associated with cognitive, particularly memory, adverse effects.

Methods

High resolution finite element human head models were generated from MRI scans of three subjects. The models were used to compare differences in activation between the three ECT placements, using subtraction maps.

Results and conclusion

In this exploratory study on three realistic head models, Bitemporal ECT resulted in greater direct stimulation of deep midline structures and also left temporal and inferior frontal regions. Interpreted in light of existing knowledge on depressive pathophysiology and cognitive neuroanatomy, it is suggested that the former sites are related to efficacy and the latter to cognitive deficits. We hereby propose an approach using binarised subtraction models that can be used to optimise, and even individualise, ECT therapies.

Keywords

DepressionElectroconvulsive therapy (ECT)Brain stimulationComputational modelEfficacyCognition
Type
Original article
Information
European Psychiatry , Volume 41 , Issue 1 , March 2017 , pp. 21 - 29
Copyright
Copyright © European Psychiatric Association 2017

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