Targeted prefrontal cortical activation with bifrontal ECT.
The anatomical brain regions involved in the therapeutic and adverse actions of electroconvulsive therapy (ECT) are unknown. Previous studies suggest that bifrontal vs. bitemporal ECT differ in therapeutic efficacy and cognitive side effects. We therefore performed cerebral blood flow (CBF) imaging during bitemporal vs. bifrontal ECT-induced seizures to identify regions crucial for the differences between these treatments. Patients with major depression, undergoing bitemporal or bifrontal ECT, were studied. Ictal-interictal SPECT images were analyzed with statistical parametric mapping for bitemporal (n=11 image pairs in 8 patients) and bifrontal (n=4 image pairs in 2 patients) ECT-induced seizures to identify regions of ictal CBF changes. Bifrontal ECT was found to cause increases in CBF in prefrontal and anterior cingulate regions. Bitemporal ECT, however, caused CBF increases in the lateral frontal cortex and in the anterior temporal lobes. In bifrontal ECT, a greater increase in prefrontal activation, while sparing the temporal lobes, may result in a better therapeutic response and fewer adverse effects on memory than bitemporal ECT.
Blumenfeld
Hal
H
Department of Neurology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, USA. hal.blumenfeld@yale.edu
McNally
Kelly A
KA
Ostroff
Robert B
RB
Zubal
I George
IG
D002560:Cerebrovascular Circulation / Q000502:physiology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004565:Electroconvulsive Therapy / Q000379:methods*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008875:Middle Aged; D010091:Oximes; D017397:Prefrontal Cortex / Q000098:blood supply*; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon
D010091:Oximes; D019275:Radiopharmaceuticals; C068296:hexamethylpropyleneamine oxime