Electroconvulsive therapy alters connectivity in treatment-resistant depressive disorders
Poster No:
84
Submission Type:
Abstract Submission
Authors:
Noora Tuovinen1, Laurin Mauracher1, Nataliia Maronchuk1, Timo Schurr1, Ruth Steiger1, Christian Siedentopf1, Elke Gizewski1, Alex Hofer1
Institutions:
1Medical University of Innsbruck, Innsbruck, Austria
First Author:
Co-Author(s):
Introduction:
Electroconvulsive therapy (ECT) is an established, safe and highly effective treatment for treatment-resistant depression. There are cognitive deficits in episodic memory and executive function following ECT, although these are mostly transient and moderate. While changes in brain morphometry following ECT are robust findings, functional connectivity findings are inconsistent. However, changes specifically in limbic connectivity have been suggested, a finding consistent with known structural modulations. One of the specific aims of our ECT-MRI project is to understand whether changes in functional connectivity occur after treatment.
Methods:
Included participants were diagnosed according to DSM-V with major depressive disorder (MDD) without psychotic features or bipolar disorder (BD) currently in a major depressive episode without psychotic features, scored ≥25 on the Montgomery-Åsberg Depression Rating Scale (MADRS), and were aged between 18 and 75 years. Neurocognitive data were assessed using the Montreal Cognitive Assessment (MoCA) and the Brief Assessment of Cognition in Schizophrenia (BACS). MRI data were acquired pre-ECT and immediately post-ECT using a Siemens Magnetom Skyra 3T whole-body scanner. T1-weighted sequence parameters were set to: repetition time (TR)=2.5s, echo time (TE)=2.18ms, inversion time=1040ms, slice thickness=0.8mm, acquisition matrix (AM)=256×256, flip angle=8°, and field of view (FOV)=256mm. Resting-state functional MRI sequence parameters were set to: TR=0.8s, TE=30ms, flip angle=52°, multiband=6, FOV=216mm, AM=90×90, slice thickness=2.4mm, and acquisition time=10 minutes. Participants were instructed to fixate to a cross shown on the screen. Functional and anatomical images were preprocessed using the standard preprocessing pipeline in CONN functional connectivity toolbox 22.a in Statistical Parametric Mapping 12. Region of interest (ROI)-to-ROI and ROI-to-voxels analyses were performed with bivariate (hrf weighting, GLM) correlation with the 32 network regions predefined in the CONN toolbox. A standard combination of an uncorrected p<0.001 height threshold (to initially define clusters of interest) and a FDR-correction of α<0.05 were used.
Results:
Twelve depressed patients (age=51.3±9.9 years, female/male=5/7, MDD/BD=10/2) were assessed before (MADRS_pre=35.5±6.8, MoCA_pre=25.9±3.4, BACS_pre=-1.3±1.1) and after ECT (MADRS_post=10.3±9.6, MoCA_post=27.0±3.0, BACS_post=-1.0±1.3, number of ECTs=8.9±2.7). ROI-to-voxels analyses revealed significant (p<0.05, FDR corrected) changes in functional connectivity induced by ECT from eight seed ROIs originating from five networks (Figure 1).
·Figure 1. Region of interest (ROI)-to-voxel analyses of functional connectivity following electroconvulsive therapy (ECT).
Conclusions:
Our preliminary results show ECT induced changes in functional connectivity, particularly in regions related to memory, emotional and motor functions. Consistent with previous studies (Fu et al., 2023; Porta-Casteràs et al., 2021; Wei et al., 2021), the results suggest an involvement of the cerebellar and limbic regions that may be related to treatment response as well as to transient cognitive deficits following ECT. More rigorous evaluation in relation to cognitive symptoms is needed.
Brain Stimulation:
Non-Invasive Stimulation Methods Other 1
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 2
Emotion, Motivation and Social Neuroscience:
Emotion and Motivation Other
Learning and Memory:
Learning and Memory Other
Modeling and Analysis Methods:
Connectivity (eg. functional, effective, structural)
Keywords:
Affective Disorders
Cerebellum
Emotions
FUNCTIONAL MRI
Limbic Systems
MRI
Psychiatric Disorders
Therapy
1|2Indicates the priority used for review
Provide references using author date format
Porta-Casteràs D, Cano M, Camprodon JA, Loo C, Palao D, Soriano-Mas C, Cardoner N. (2021), 'A multimetric systematic review of fMRI findings in patients with MDD receiving ECT', Prog Neuropsychopharmacol Biol Psychiatry, vol. 108, pp. 110178.
Wei Q, Ji Y, Bai T, Zu M, Guo Y, Mo Y, Ji G, Wang K, Tian Y. (2021), 'Enhanced cerebro-cerebellar functional connectivity reverses cognitive impairment following electroconvulsive therapy in major depressive disorder', Brain Imaging Behav, vol. 15, no. 2, pp. 798-806.