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


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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    • "These studies, however, have various limitations, including representing the electrodes as point sources, truncated or 2D head models, and models limited to the BL and RUL electrode placements. Except for a recent study by our group [29], none of these works has modeled the BF and FEAST electrode configurations. Furthermore, even though a significant number of papers on TMS electric field modeling have been published [24–26, 30–36], none of them analyzes MST-specific devices and coils. "
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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.
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