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Published on: August 11, 2015
Brain Volumetric Correlates of Right Unilateral Versus Bitemporal Electroconvulsive Therapy for Treatment-Resistant
Marta Cano1, Erik Lee1, Narcís Cardoner1
1From the Department of Psychiatry, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona (MC, IM-Z, RH-R, OC-R, JMM, MU, CS-M); the Department of Clinical Sciences, School of Medicine, University of Barcelona (MC, IM-Z, RH-R, JMM, MU); CIBERSAM, Carlos III Health Institute, Madrid (MC, NC, JP, EV, RH-R, OC-R, JMM, MU, CS-M); the Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston (MC, EL, NM, MH, JAC); the Mental Health Department, Parc Taulí Sabadell, Universitat Autònoma de Barcelona (NC); the Radiology Department, MRI Research Unit, Hospital del Mar, Barcelona (JP); Sant Joan de Déu Barcelona-Children's Hospital, Barcelona (EV); and the Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona (CS-M).
Objective:
The selection of a bitemporal (BT) or right unilateral (RUL) electrode placement affects the efficacy and side effects of ECT. Previous studies have not entirely described the neurobiological underpinnings of such differential effects. Recent neuroimaging research on gray matter volumes is contributing to our understanding of the mechanism of action of ECT and could clarify the differential mechanisms of BT and RUL ECT.
Methods:
To assess the whole-brain gray matter volumetric changes observed after treating patients with treatment-resistant depression with BT or RUL ECT, the authors used MRI to assess 24 study subjects with treatment-resistant depression (bifrontotemporal ECT, N=12; RUL ECT, N=12) at two time points (before the first ECT session and after ECT completion).
Results:
Study subjects receiving BT ECT showed gray matter volume increases in the bilateral limbic system, but subjects treated with RUL ECT showed gray matter volume increases limited to the right hemisphere. The authors observed significant differences between the two groups in midtemporal and subcortical limbic structures in the left hemisphere.
Conclusions:
These findings highlight that ECT-induced gray matter volume increases may be specifically observed in the stimulated hemispheres. The authors suggest that electrode placement may relevantly contribute to the development of personalized ECT protocols.
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