Electroconvulsive therapy of depression in patients with white matter hyperintensity
- [Show abstract] [Hide abstract] ABSTRACT: Differential specialization of the cerebral hemispheres for cognitive functioning is well established. A converging body of clinical and experimental studies conducted with brain-damaged patients, normal subjects, and psychiatric patients is reviewed which indicates that there is also hemispheric asymmetry in the regulation of emotional behavior. These data indicate that the right hemisphere may be uniquely specialized for the perception, experience, and expression of emotion. Theories to account for this hemispheric asymmetry are reviewed and a right-hemisphere dominance model is proposed. Future studies are outlined to further our understanding of the neuroanatomic basis of emotion. The recognition that the right hemisphere may be specialized for mediating emotion may have clinical implications.0Comments 48Citations
- [Show abstract] [Hide abstract] ABSTRACT: Using brain magnetic resonance imaging (MRI) and high-resolution computed tomography (CT), we identified changes in the subcortical white matter in 44 of 67 elderly depressed inpatients (66%) referred for electroconvulsive therapy (ECT). This "leukoencephalopathy" was frequently associated with other structural brain changes, including cortical atrophy, lateral ventricular enlargement, and lacunar infarctions of the basal ganglia and thalamus. Many (58%) of the patients had developed late-onset depressive disorders, and the majority (86%) had been refractory to and/or intolerant of antidepressant drug therapy. Nevertheless, all but 1 of the 44 patients subsequently responded to a course of ECT, which in general was well tolerated. Although the precise etiology of the leukoencephalopathy remains unclear, clinical data suggest that it may result from arteriosclerotic disease of the medullary arteries that supply the subcortical brain regions. Several lines of evidence suggest that leukoencephalopathy may have implications for the pathophysiology of depressive illness, at least in some elderly patients.0Comments 152Citations
- [Show abstract] [Hide abstract] ABSTRACT: The comparative prevalence of leukoencephalopathic changes in 119 young and old inpatients and outpatients with major depression was examined. Patients underwent magnetic resonance imaging (MRI) examinations with T1- and T2-weighted pulse sequences. Leukoencephalopathic changes were uncommon in depressed patients and medical control subjects younger than 45 years of age. Such changes were, however, seen in approximately 44% of older depressed patients and 30% of elderly medical control subjects.0Comments 24Citations
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