A computational model of direct brain excitation induced by electroconvulsive therapy: Comparison among three conventional electrode placements

被引:51
作者
Bai, Siwei [1 ]
Loo, Colleen [2 ,3 ,4 ]
Al Abed, Amr [1 ]
Dokos, Socrates [1 ]
机构
[1] Univ New S Wales, Fac Engn, Grad Sch Biomed Engn, Sydney, NSW 2052, Australia
[2] Univ New S Wales, Sch Psychiat, Sydney, NSW 2052, Australia
[3] St George Hosp, Dept Psychiat, Sydney, NSW, Australia
[4] Black Dog Inst, Sydney, NSW, Australia
关键词
electroconvulsive therapy; brain stimulation; computational model; excitable tissue; electrode placement; stimulus parameters; TRANSCRANIAL MAGNETIC STIMULATION; IN-VIVO; ELECTRICAL-PROPERTIES; MAJOR DEPRESSION; UNILATERAL ECT; HUMAN SKULL; HUMAN HEAD; CONDUCTIVITY; EFFICACY; STIMULUS;
D O I
10.1016/j.brs.2011.07.004
中图分类号
R74 [神经病学与精神病学];
学科分类号
100204 [神经病学];
摘要
Background Electroconvulsive therapy (ECT) is a highly effective treatment for severe depressive disorder. Efficacy and cognitive outcomes have been shown to depend on variations in electrode placement and other stimulus parameters, presumably because of differences in the pattern of neuronal activation. This latter effect, however, is poorly understood. Objective In this study, we present an anatomically accurate human head computational model to stimulate neuronal excitation during ECT, to better understand the effects of varying electrode placement and stimulus parameters. Methods Electric field and current density throughout the head, as well as direct neural activation within the brain, were computed using the finite element method. Regions representing passive volume conductors (skin, skull, cerebrospinal fluid) were extracellularly coupled to an excitable neural continuum region representing the brain. The skull was modeled with anistropic electrical conductivity. Results Simulation results indicated that direct activation of the brain occurred immediately beneath the electrodes on the scalp, consistent with existing imaging studies. In addition, we found that the brainstem was also activated using a right unilateral electrode configuration. Simulation also demonstrated that a reduction in stimulus amplitude or pulse width led to a reduction in the spatial extent of brain activation. Conclusions The novel model described in this study was able to simulate direct excitation of the brain during ECT, was useful in characterizing differences in neuronal activation as electrode placement, pulse width, and amplitude were altered, and is proposed as a tool for further exploring the effects of variations in ECT stimulation approaches. Results from the simulations assist in understanding recently described clinical phenomena, in particular, the reduction in cognitive side effects with ultrabrief pulse width stimulation, and greater effects of the ECT stimulus on cardiovascular function with unilateral electrode placement. Crown Copyright (C) 2012 Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:408 / 421
页数:14
相关论文
共 56 条
[1]
Abrams R., 2002, Electroconvulsive Therapy, V4th
[2]
Conductivities of three-layer live human skull [J].
Akhtari, M ;
Bryant, HC ;
Marnelak, AN ;
Flynn, ER ;
Heller, L ;
Shih, JJ ;
Mandelkern, M ;
Matlachov, A ;
Ranken, DM ;
Best, ED ;
DiMauro, MA ;
Lee, RR ;
Sutherling, WW .
BRAIN TOPOGRAPHY, 2002, 14 (03) :151-167
[3]
[Anonymous], 1968, HUMAN BRAIN FIGURES
[4]
Comparison of bifrontal and bitemporal ECT for major depression [J].
Bailine, SH ;
Rifkin, A ;
Kayne, E ;
Selzer, JA ;
Vital-Herne, J ;
Blieka, M ;
Pollack, S .
AMERICAN JOURNAL OF PSYCHIATRY, 2000, 157 (01) :121-123
[5]
The electrical conductivity of human cerebrospinal fluid at body temperature [J].
Baumann, SB ;
Wozny, DR ;
Kelly, SK ;
Meno, FM .
IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING, 1997, 44 (03) :220-223
[6]
Targeted prefrontal cortical activation with bifrontal ECT [J].
Blumenfeld, H ;
McNally, KA ;
Ostroff, RB ;
Zubal, IG .
PSYCHIATRY RESEARCH-NEUROIMAGING, 2003, 123 (03) :165-170
[7]
Selective frontal, parietal, and temporal networks in generalized seizures [J].
Blumenfeld, H ;
Westerveld, M ;
Ostroff, RB ;
Vanderhill, SD ;
Freeman, J ;
Necochea, A ;
Uranga, P ;
Tanhehco, T ;
Smith, A ;
Seibyl, JP ;
Stokking, R ;
Studholme, C ;
Spencer, SS ;
Zubale, IG .
NEUROIMAGE, 2003, 19 (04) :1556-1566
[8]
Analysis of the quasi-static approximation for calculating potentials generated by neural stimulation [J].
Bossetti, Chad A. ;
Birdno, Merrill J. ;
Grill, Warren M. .
JOURNAL OF NEURAL ENGINEERING, 2008, 5 (01) :44-53
[9]
Carney S, 2003, LANCET, V361, P799
[10]
A report on mood and cognitive outcomes with right unilateral ultrabrief pulsewidth (0.3 ms) ECT and retrospective comparison with standard pulsewidth right unilateral ECT [J].
Colleen, Loo ;
Sheehan, Patrick ;
Pigot, Melissa ;
Lyndon, William .
JOURNAL OF AFFECTIVE DISORDERS, 2007, 103 (1-3) :277-281