Regional Electric Field Induced by Electroconvulsive Therapy: A Finite Element Simulation Study

Department of Biomedical Engineering, Columbia University, New York, NY 10032, USA.
Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2010; 2010:2045-8. DOI: 10.1109/IEMBS.2010.5626553
Source: PubMed

ABSTRACT The goal of this study is to investigate the regional distribution of the electric field (E-field) strength induced by electroconvulsive therapy (ECT), and to contrast clinically relevant electrode configurations through finite element (FE) analysis. An FE human head model incorporating tissue heterogeneity and white matter anisotropy was generated based on structural magnetic resonance imaging (MRI) and diffusion tensor MRI (DT-MRI) data. We simulated the E-field spatial distributions of three standard ECT electrode placements [bilateral (BL), bifrontal (BF), and right unilateral (RUL)] and an investigational electrode configuration [focal electrically administered seizure therapy (FEAST)]. A quantitative comparison of the E-field strength was subsequently carried out in various brain regions of interests (ROIs) that have putative role in the therapeutic action and/or adverse side effects of ECT. This study illustrates how the realistic FE head model provides quantitative insight in the biophysics of ECT, which may shed light on the differential clinical outcomes seen with various forms of ECT, and may guide the development of novel stimulation paradigms with improved risk/benefit ratio.

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Available from: Angel V Peterchev, Oct 04, 2014
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    • "Antidepressant effects of FEAST are yet to be reported. Work on novel electrode placements for ECT may be informed by realistic head modeling of the field distributions in the brain, such that dosing paradigms could be designed to target brain regions implicated in depression while avoiding those associated with adverse side effects (Lee et al, 2010). "
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    ABSTRACT: We present the first computational study comparing the electric field induced by various electroconvulsive therapy (ECT) and magnetic seizure therapy (MST) paradigms. Four ECT electrode configurations (bilateral, bifrontal, right unilateral, and focal electrically administered seizure therapy) and three MST coil configurations (circular, cap, and double cone) were modeled. The model incorporated a modality-specific neural activation threshold. ECT (0.3 ms pulse width) and MST induced the maximum electric field of 2.1-2.5 V cm⁻¹ and 1.1-2.2 V cm⁻¹ in the brain, corresponding to 6.2-7.2 times and 1.2-2.3 times the neural activation threshold, respectively. The MST electric field is more confined to the superficial cortex compared to ECT. The brain volume stimulated was much larger with ECT (up to 100%) than with MST (up to 8.2%). MST with the double-cone coil was the most focal, and bilateral ECT was the least focal. Our results suggest a possible biophysical explanation of the reduced side effects of MST compared to ECT. Our results also indicate that the conventional ECT pulse amplitude (800-900 mA) is much higher than necessary for seizure induction. Reducing the ECT pulse amplitude should be explored as a potential means of diminishing side effects.
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    ABSTRACT: Electroconvulsive therapy (ECT) is a highly effective treatment for severe depressive disorder. Efficacy and cognitive outcomes have been shown to depend on variations in treatment technique. A high resolution finite element model of a human head was generated from MRI scans and implemented with tissue heterogeneity and an excitable ionic neural model incorporated in the brain. The model was used to compare the effects of three common ECT electrode configurations, including the spatial profiles of electric field and excitation in the brain. The results showed that electrode placement has a significant effect in determining the spatial extent of activation in different brain regions, which would account for differences seen in clinical outcomes.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2011; 2011:5484-7. DOI:10.1109/IEMBS.2011.6091399
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