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Besse M, Belz M, Bartels C, Herzig B, Wiltfang J, Zilles-Wegner D. The myth of brain damage: no change of neurofilament light chain during transient cognitive side-effects of ECT. Eur Arch Psychiatry Clin Neurosci 2024; 274:1187-1195. [PMID: 37656172 PMCID: PMC11226499 DOI: 10.1007/s00406-023-01686-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
Electroconvulsive therapy (ECT) is an effective, safe, and mostly well-tolerated treatment for patients with severe or difficult to treat depression or psychotic disorders. However, a relevant number of patients experience subjective and/or objective cognitive side-effects. The mechanism of these transient deficits is not yet clear. Thus, our study prospectively investigated neurofilament light chain (NfL) concentrations as a highly sensitive biomarker for neuroaxonal damage along with cognitive performance during a course of ECT. Serum NfL concentrations from 15 patients with major depressive disorder receiving ECT were analyzed (1) 24 h before the first ECT, (2) 24 h and (3) 7 days after the last ECT (45 measurements in total). Neuropsychological testing including memory, executive functions and attention was performed at each time-point. NfL concentrations did not change between the three time-points, while a temporary cognitive impairment was found. Even in the subset of patients with the strongest impairment, NfL concentrations remained unchanged. Neuropsychological testing revealed the common pattern of transient cognitive side-effects with reduced performance 24 h post-ECT (global cognition score: p < 0.001; memory: p = 0.043; executive functions: p = 0.002) and return to baseline after 7 days (all p < 0.001). Our study adds to the evidence that neither ECT per se nor the transient cognitive side-effects seem to be associated with an increase of NfL as a marker of neuroaxonal damage. In contrast, we discuss cognitive side effects to be potentially interpreted as a byproduct of ECT's neuroplastic effects.
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Affiliation(s)
- Matthias Besse
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Strasse 5, 37075, Göttingen, Germany.
| | - Michael Belz
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Strasse 5, 37075, Göttingen, Germany
| | - Claudia Bartels
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Strasse 5, 37075, Göttingen, Germany
| | - Bettina Herzig
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Strasse 5, 37075, Göttingen, Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Strasse 5, 37075, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany
- Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - David Zilles-Wegner
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Strasse 5, 37075, Göttingen, Germany
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Westlin C, Guthrie AJ, Paredes-Echeverri S, Maggio J, Finkelstein S, Godena E, Millstein D, MacLean J, Ranford J, Freeburn J, Adams C, Stephen C, Diez I, Perez DL. Machine learning classification of functional neurological disorder using structural brain MRI features. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333499. [PMID: 39033019 DOI: 10.1136/jnnp-2024-333499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Brain imaging studies investigating grey matter in functional neurological disorder (FND) have used univariate approaches to report group-level differences compared with healthy controls (HCs). However, these findings have limited translatability because they do not differentiate patients from controls at the individual-level. METHODS 183 participants were prospectively recruited across three groups: 61 patients with mixed FND (FND-mixed), 61 age-matched and sex-matched HCs and 61 age, sex, depression and anxiety-matched psychiatric controls (PCs). Radial basis function support vector machine classifiers with cross-validation were used to distinguish individuals with FND from HCs and PCs using 134 FreeSurfer-derived grey matter MRI features. RESULTS Patients with FND-mixed were differentiated from HCs with an accuracy of 0.66 (p=0.005; area under the receiving operating characteristic (AUROC)=0.74); this sample was also distinguished from PCs with an accuracy of 0.60 (p=0.038; AUROC=0.56). When focusing on the functional motor disorder subtype (FND-motor, n=46), a classifier robustly differentiated these patients from HCs (accuracy=0.72; p=0.002; AUROC=0.80). FND-motor could not be distinguished from PCs, and the functional seizures subtype (n=23) could not be classified against either control group. Important regions contributing to statistically significant multivariate classifications included the cingulate gyrus, hippocampal subfields and amygdalar nuclei. Correctly versus incorrectly classified participants did not differ across a range of tested psychometric variables. CONCLUSIONS These findings underscore the interconnection of brain structure and function in the pathophysiology of FND and demonstrate the feasibility of using structural MRI to classify the disorder. Out-of-sample replication and larger-scale classifier efforts incorporating psychiatric and neurological controls are needed.
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Affiliation(s)
- Christiana Westlin
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew J Guthrie
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sara Paredes-Echeverri
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julie Maggio
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sara Finkelstein
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ellen Godena
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Millstein
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julie MacLean
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jessica Ranford
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Occupational Therapy, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jennifer Freeburn
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Caitlin Adams
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Stephen
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Movement Disorders Division, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ibai Diez
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David L Perez
- Functional Neurological Disorder Research Group, Division of Behavioral Neurology & Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Macoveanu J, Craciun S, Ketterer-Sykes EB, Ysbæk-Nielsen AT, Zarp J, Kessing LV, Jørgensen MB, Miskowiak KW. Amygdala and hippocampal substructure volumes and their association with improvement in mood symptoms in patients with mood disorders undergoing electroconvulsive therapy. Psychiatry Res Neuroimaging 2024; 343:111859. [PMID: 38986265 DOI: 10.1016/j.pscychresns.2024.111859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 07/05/2024] [Accepted: 07/05/2024] [Indexed: 07/12/2024]
Abstract
Electroconvulsive therapy (ECT) demonstrates favorable outcomes in the management of severe depressive disorders. ECT has been consistently associated with volumetric increases in the amygdala and hippocampus. However, the underlying mechanisms of these structural changes and their association to clinical improvement remains unclear. In this cross-sectional structural MRI study, we assessed the difference in amygdala subnuclei and hippocampus subfields in n = 37 patients with either unipolar or bipolar disorder immediately after eighth ECT sessions compared to (n = 40) demographically matched patients in partial remission who did not receive ECT (NoECT group). Relative to NoECT, the ECT group showed significantly larger bilateral amygdala volumes post-treatment, with the effect originating from the lateral, basal, and paralaminar nuclei and the left corticoamydaloid transition area. No significant group differences were observed for the hippocampal or cortical volumes. ECT was associated with a significant decrease in depressive symptoms. However, there were no significant correlations between amygdala subnuclei volumes and symptom improvement. Our study corroborates previous reports on increased amygdalae volumes following ECT and further identifies the subnuclei driving this effect. However, the therapeutic effect of ECT does not seem to be directly related to structural changes in the amygdala.
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Affiliation(s)
- Julian Macoveanu
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark; Neurocogntion and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
| | - Sabina Craciun
- DIS Copenhagen, Copenhagen, Denmark; Dickinson College, Carlisle, PA, USA
| | | | - Alexander Tobias Ysbæk-Nielsen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark; Neurocogntion and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Jeff Zarp
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark; Neurocogntion and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark
| | - Martin Balslev Jørgensen
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Copenhagen, Denmark; Neurocogntion and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, and Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Lundin RM, Falcao VP, Kannangara S, Eakin CW, Abdar M, O'Neill J, Khosravi A, Eyre H, Nahavandi S, Loo C, Berk M. Machine Learning in Electroconvulsive Therapy: A Systematic Review. J ECT 2024:00124509-990000000-00167. [PMID: 38857315 DOI: 10.1097/yct.0000000000001009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
ABSTRACT Despite years of research, we are still not able to reliably predict who might benefit from electroconvulsive therapy (ECT) treatment. As we exhaust what is possible using traditional statistical analysis, ECT remains a good candidate for machine learning approaches due to the large data sets with data captured through electroencephalography (EEG) and other objective measures. A systematic review of 6 databases led to the full-text examination of 26 articles using machine learning approaches in examining data predicting response to ECT treatment. The identified articles used a wide variety of data types covering structural and functional imaging data (n = 15), clinical data (n = 5), a combination of clinical and imaging data (n = 2), EEG (n = 3), and social media posts (n = 1). The clinical indications in which response prediction was assessed were depression (n = 21) and psychosis (n = 4). Changes in multiple anatomical regions in the brain were identified as holding a predictive value for response to ECT. These primarily centered on the limbic system and associated networks. Clinical features predicting good response to ECT in depression included shorter duration, lower severity, higher medication dose, psychotic features, low cortisol levels, and positive family history. It has also been possible to predict the likelihood of relapse of readmission with psychosis after ECT treatment, including a better response if higher transfer entropy was calculated from EEG signals. A transdisciplinary approach with an international consortium collecting a wide range of retrospective and prospective data may help to refine and extend these outcomes and translate them into clinical practice.
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Affiliation(s)
| | | | | | - Charles W Eakin
- From the Mental Health, Drug and Alcohol Services, Barwon Health
| | - Moloud Abdar
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, Victoria, Australia
| | - John O'Neill
- Waikato District Health Board, Hamilton, New Zealand
| | - Abbas Khosravi
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, Victoria, Australia
| | | | - Saeid Nahavandi
- Institute for Intelligent Systems Research and Innovation, Deakin University, Geelong, Victoria, Australia
| | | | - Michael Berk
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
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Chen J, Wang J, Duan K, Li X, Pan Z, Zhang J, Qin X, Hu Y, Lyu H. Selective vulnerability of hippocampal sub-regions in patients with subcortical vascular mild cognitive impairment. Brain Imaging Behav 2024:10.1007/s11682-024-00881-y. [PMID: 38642314 DOI: 10.1007/s11682-024-00881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 04/22/2024]
Abstract
Early diagnosis of subcortical vascular mild cognitive impairment (svMCI) is clinically essential because it is the most reversible subtype of all cognitive impairments. Since structural alterations of hippocampal sub-regions have been well studied in neurodegenerative diseases with pathophysiological cognitive impairments, we were eager to determine whether there is a selective vulnerability of hippocampal sub-fields in patients with svMCI. Our study included 34 svMCI patients and 34 normal controls (NCs), with analysis of T1 images and Montreal Cognitive Assessment (MoCA) scores. Gray matter volume (GMV) of hippocampal sub-regions was quantified and compared between the groups, adjusting for age, sex, and education. Additionally, we explored correlations between altered GMV in hippocampal sub-fields and MoCA scores in svMCI patients. Patients with svMCI exhibited selectively reduced GMV in several left hippocampal sub-regions, such as the hippocampal tail, hippocampal fissure, CA1 head, ML-HP head, CA4 head, and CA3 head, as well as decreased GMV in the right hippocampal tail. Specifically, GMV in the left CA3 head was inversely correlated with MoCA scores in svMCI patients. Our findings indicate that the atrophy pattern of patients with svMCI was predominantly located in the left hippocampal sub-regions. The left CA3 might be a crucial area underlying the distinct pathophysiological mechanisms of cognitive impairments with subcortical vascular origins.
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Affiliation(s)
- Jianxiang Chen
- Department of Radiology, The Fourth Clinical Medical College, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jianjun Wang
- Department of Neurology and Psychology, The Fourth Clinical Medical College, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Ke Duan
- Department of Radiology, The Fourth Clinical Medical College, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xinbei Li
- Department of Radiology, The Fourth Clinical Medical College, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Zhongxian Pan
- Department of Radiology, The Fourth Clinical Medical College, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jinhuan Zhang
- Department of Acupuncture and Moxibustion, The Fourth Clinical Medical College, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Xiude Qin
- Department of Neurology and Psychology, The Fourth Clinical Medical College, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China.
| | - Yuanming Hu
- Department of Radiology, The Fourth Clinical Medical College, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China.
| | - Hanqing Lyu
- Department of Radiology, The Fourth Clinical Medical College, Shenzhen Traditional Chinese Medicine Hospital, Guangzhou University of Chinese Medicine, Shenzhen, China.
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Nasrullah N, Kerr WT, Stern JM, Wang Y, Tatekawa H, Lee JK, Karimi AH, Sreenivasan SS, Engel J, Eliashiv DE, Feusner JD, Salamon N, Savic I. Amygdala subfield and prefrontal cortex abnormalities in patients with functional seizures. Epilepsy Behav 2023; 145:109278. [PMID: 37356226 DOI: 10.1016/j.yebeh.2023.109278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Functional seizures (FS) are paroxysmal episodes, resembling epileptic seizures, but without underlying epileptic abnormality. The aetiology and neuroanatomic associations are incompletely understood. Recent brain imaging data indicate cerebral changes, however, without clarifying possible pathophysiology. In the present study, we specifically investigated the neuroanatomic changes in subregions of the amygdala and hippocampus in FS. METHODS T1 MRI scans of 37 female patients with FS and 37 age-matched female seizure naïve controls (SNC) were analyzed retrospectively in FreeSurfer version 7.1. Seizure naïve controls included patients with depression and anxiety disorders. The analysis included whole-brain cortical thickness, subcortical volumes, and subfields of the amygdala and hippocampus. Group comparisons were carried out using multivariable linear models. RESULTS The FS and SNC groups did not differ in the whole hippocampus and amygdala volumes. However, patients had a significant reduction of the right lateral amygdala volume (p = 0.00041), an increase of the right central amygdala, (p = 0.037), and thinning of the left superior frontal gyrus (p = 0.024). Additional findings in patients were increased volumes of the right medial amygdala (p = 0.031), left anterior amygdala (p = 0.017), and left dentate gyrus of the hippocampus (p = 0.035). CONCLUSIONS The observations from the amygdala and hippocampus segmentation affirm that there are neuroanatomic associations of FS. The pattern of these changes aligned with some of the cerebral changes described in chronic stress conditions and depression. The pattern of detected changes further study, and may, after validation, provide biomarkers for diagnosis and treatment.
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Affiliation(s)
- Nilab Nasrullah
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Neurology Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Wesley T Kerr
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - John M Stern
- Department of Neurology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Yanlu Wang
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Hiroyuki Tatekawa
- Department of Radiology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - John K Lee
- Department of Neurology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Amir H Karimi
- Department of Neurology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Siddhika S Sreenivasan
- Department of Neurology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Jerome Engel
- Department of Neurology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Brain Research Institute, University of California Los Angeles, Los Angeles, CA, USA; Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Dawn E Eliashiv
- Department of Neurology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Jamie D Feusner
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA; Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Noriko Salamon
- Department of Radiology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Ivanka Savic
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden; Neurology Clinic, Karolinska University Hospital, Stockholm, Sweden; Department of Neurology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA.
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Huang X, Zhuo Y, Wang X, Xu J, Yang Z, Zhou Y, Lv H, Ma X, Yan B, Zhao H, Yu H. Structural and functional improvement of amygdala sub-regions in postpartum depression after acupuncture. Front Hum Neurosci 2023; 17:1163746. [PMID: 37266323 PMCID: PMC10229903 DOI: 10.3389/fnhum.2023.1163746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/11/2023] [Indexed: 06/03/2023] Open
Abstract
Objective This study aimed to analyze the changes in structure and function in amygdala sub-regions in patients with postpartum depression (PPD) before and after acupuncture. Methods A total of 52 patients with PPD (All-PPD group) were included in this trial, 22 of which completed 8 weeks of acupuncture treatment (Acu-PPD group). An age-matched control group of 24 healthy postpartum women (HPW) from the hospital and community were also included. Results from the 17-Hamilton Depression Scale (17-HAMD) and the Edinburgh Postnatal Depression Scale (EPDS) were evaluated, and resting-state functional magnetic resonance imaging (rs-fMRI) scans were performed at baseline and after the acupuncture treatment. Sub-regions of the amygdala were used as seed regions to measure gray matter volume (GMV) and analyzed for resting-state functional connectivity (RSFC) values separately. Finally, correlation analyses were performed on all patients with PPD to evaluate association values between the clinical scale scores, GMV, and RSFC values, while controlling for age and education. Pearson's correlation analyses were conducted to investigate the relevance between GMV and RSFC values of brain regions that differed before and after acupuncture treatment and clinical scale scores in Acu-PPD patients. Results The HAMD scores for Acu-PPD were reduced after acupuncture treatment (P < 0.05), suggesting the positive effects of acupuncture on depression symptoms. Structurally, the All-PPD group showed significantly decreased GMV in the left lateral part of the amygdala (lAMG.L) and the right lateral part of the amygdala (lAMG.R) compared to the HPW group (P < 0.05). In addition, the GMV of lAMG.R was marginally increased in the Acu-PPD group after acupuncture (P < 0.05). Functionally, the Acu-PPD group showed a significantly enhanced RSFC between the left medial part of the amygdala (mAMG.L) and the left vermis_6, an increased RSFC between the right medial part of the amygdala (mAMG.R) and left vermis_6, and an increased RSFC between the lAMG.R and left cerebelum_crus1 (P < 0.05). Moreover, correlation studies revealed that the GMV in the lAMG.R was significantly related to the EPDS scores in the All-PPD group (P < 0.05). Conclusion Our findings demonstrated that the structure of amygdala sub-regions is impaired in patients with PPD. Acupuncture may improve depressive symptoms in patients with PPD, and the mechanism may be attributed to changes in the amygdala sub-region structure and the functional connections of brain areas linked to the processing of negative emotions. The fMRI-based technique can provide comprehensive neuroimaging evidence to visualize the central mechanism of action of acupuncture in PPD.
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Affiliation(s)
- Xingxian Huang
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
- Acupuncture Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
- Shenzhen Key Laboratory of Modern Applied Research on Acupuncture and Moxibustion, Shenzhen, China
| | - Yuanyuan Zhuo
- Acupuncture Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
- Shenzhen Key Laboratory of Modern Applied Research on Acupuncture and Moxibustion, Shenzhen, China
| | - Xinru Wang
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Jinping Xu
- CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zhuoxin Yang
- Acupuncture Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
- Shenzhen Key Laboratory of Modern Applied Research on Acupuncture and Moxibustion, Shenzhen, China
| | - Yumei Zhou
- Acupuncture Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
- Shenzhen Key Laboratory of Modern Applied Research on Acupuncture and Moxibustion, Shenzhen, China
| | - Hanqing Lv
- Acupuncture Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Xiaoming Ma
- Acupuncture Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
- Shenzhen Key Laboratory of Modern Applied Research on Acupuncture and Moxibustion, Shenzhen, China
| | - Bin Yan
- Acupuncture Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
- Shenzhen Key Laboratory of Modern Applied Research on Acupuncture and Moxibustion, Shenzhen, China
| | - Hong Zhao
- Luohu District of Hospital of Traditional Chinese Medicine, Shenzhen, China
| | - Haibo Yu
- Acupuncture Department, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
- Shenzhen Key Laboratory of Modern Applied Research on Acupuncture and Moxibustion, Shenzhen, China
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8
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Cai H, Du R, Yang K, Li W, Wang Z. Association between electroconvulsive therapy and depressive disorder from 2012 to 2021: Bibliometric analysis and global trends. Front Hum Neurosci 2022; 16:1044917. [DOI: 10.3389/fnhum.2022.1044917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022] Open
Abstract
BackgroundDepressive disorder is a chronic mental illness that is vulnerable to relapse, imposes a huge economic burden on society and patients, and is a major global public health problem. Depressive disorders are characterized by depressed mood, decreased energy and interest, and suicidal ideation and behavior in severe cases. They can be treated through pharmacotherapy and psychotherapy or physical treatments such as electroconvulsive therapy (ECT). In patients with suicidal ideation, behavior, or refractory depressive disorder ECT has a faster onset of action and better efficacy than pharmacotherapy. This study used bibliometric and visual analyses to map the current state of global research on ECT for depressive disorder and to predict future research trends in this area.Materials and methodsA literature search was performed for studies on ECT and depressive disorder in the Web of Science Core Collection (WoSCC) database. All studies considered for this paper were published between 2012 and 2021. Bibliometric and co-occurrence analyses were performed using the CiteSpace software.ResultsIn total, 2,184 publications were retrieved. The number of publications on ECT and depressive disorder have been increasing since 2012, with China being a emerging hub with a growing influence in the field. Zafiris J. Daskalakis is the top author in terms of number of publications, and The Journal of ECT is not only the most published journal but also the most co-cited journal in the field. Co-occurrence analysis showed that electroconvulsive therapy, treatment-resistant depression, bipolar disorder, hippocampus, efficacy, and electrode placement are current research hotspots. Molecular biomarkers, neuroimaging predictors, and late-life depression will become research hotspots in the future.ConclusionOur analysis made it possible to observe an important growth of the field since 2012, to identify key scientific actors in this growth and to predict hot topics for future research.
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