Postictal agitation is associated with brain-wide postictal microstructural changes after electroconvulsive...

Area of Science:

• Neuroscience
• Radiology
• Psychiatry

Background:

• Electroconvulsive therapy (ECT) effectively treats depression but can cause postictal agitation.
• The underlying mechanisms of postictal symptoms remain largely unknown.
• This study investigates the link between immediate postictal diffusivity changes and postictal symptoms.

Purpose of the Study:

• To determine if immediate postictal diffusivity changes are associated with postictal symptoms after electroconvulsive therapy (ECT).
• To explore the relationship between diffusion tensor imaging (DTI) metrics and postictal agitation or reorientation time.

Main Methods:

• A randomized cross-over trial involving 22 patients undergoing ECT.
• Diffusion tensor imaging (DTI) scans acquired pre-ECT and three times postictally.
• Analysis using mixed effects models, Generalized Estimating Equations, and Tract-Based Spatial Statistics (TBSS) to assess fractional anisotropy (FA) and mean diffusivity (MD).

Main Results:

• Postictal agitation correlated with decreased mean FA (p=0.02) and increased mean MD (p=0.04) in white matter.
• Voxel-wise analysis indicated FA reductions in the left anterior limb of the internal capsule associated with agitation.
• No significant associations were found with baseline MD or FA values, nor with reorientation time.

Conclusions:

• Immediate postictal agitation following ECT is associated with widespread changes in brain white matter diffusivity.
• These findings highlight a potential role for altered tissue microstructure in the acute phase after ECT-induced seizures.
• The results suggest a clinically relevant connection between microstructural brain changes and postictal agitation.