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Meta-analysis of brain structural changes after electroconvulsive therapy in depression

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Title: Meta-analysis of brain structural changes after electroconvulsive therapy in depression
Authors: Gregor Gryglewski, Rupert Lanzenberger, Leo R. Silberbauer, Daniel Pacher, Siegfried Kasper, Rainer Rupprecht, Richard Frey, Pia Baldinger-Melich
Source: Brain Stimulation, Vol 14, Iss 4, Pp 927-937 (2021)
Publisher Information: Elsevier, 2021.
Publication Year: 2021
Collection: LCC:Neurosciences. Biological psychiatry. Neuropsychiatry
Subject Terms: Electroconvulsive therapy, Volume, Hippocampus, Hippocampal subfields, Dentate gyrus, Meta-analysis, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
More Details: Background: Increases in the volume of the amygdala and hippocampus after electroconvulsive therapy (ECT) are among the most robust effects known to the brain-imaging field. Recent advances in the segmentation of substructures of these regions allow for novel insights on the relationship between brain structure and clinical outcomes of ECT. Objective: We aimed to provide a comprehensive synthesis of evidence available on changes in brain structure after ECT, including recently published data on hippocampal subfields. Methods: A meta-analysis of published studies was carried out using random-effects models of standardized mean change of regional brain volumes measured with longitudinal magnetic resonance imaging of depressive patients before and after a series of ECT. Results: Data from 21 studies (543 depressed patients) were analysed, including 6 studies (118 patients) on hippocampal subfields. Meta-analyses could be carried out for seven brain regions for which data from at least three published studies was available. We observed increases in left and right hippocampi, amygdalae, cornua ammonis (CA) 1, CA 2/3, dentate gyri (DG) and subicula with standardized mean change scores ranging between 0.34 and 1.15. The model did not reveal significant volume increases in the caudate. Meta-regression indicated a negative relationship between the reported increases in the DG and relative symptom improvement (−0.27 (SE: 0.09) per 10%). Conclusions: ECT is accompanied by significant volume increases in the bilateral hippocampus and amygdala that are not associated with treatment outcome. Among hippocampal subfields, the most robust volume increases after ECT were measured in the dentate gyrus. The indicated negative correlation of this effect with antidepressant efficacy warrants replication in data of individual patients.
Document Type: article
File Description: electronic resource
Language: English
ISSN: 1935-861X
Relation: http://www.sciencedirect.com/science/article/pii/S1935861X21001145; https://doaj.org/toc/1935-861X
DOI: 10.1016/j.brs.2021.05.014
Access URL: https://doaj.org/article/f46c3529b8c446a89aa05a8f2b252909
Accession Number: edsdoj.f46c3529b8c446a89aa05a8f2b252909
Database: Directory of Open Access Journals
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  Data: Brain Stimulation, Vol 14, Iss 4, Pp 927-937 (2021)
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  Data: Background: Increases in the volume of the amygdala and hippocampus after electroconvulsive therapy (ECT) are among the most robust effects known to the brain-imaging field. Recent advances in the segmentation of substructures of these regions allow for novel insights on the relationship between brain structure and clinical outcomes of ECT. Objective: We aimed to provide a comprehensive synthesis of evidence available on changes in brain structure after ECT, including recently published data on hippocampal subfields. Methods: A meta-analysis of published studies was carried out using random-effects models of standardized mean change of regional brain volumes measured with longitudinal magnetic resonance imaging of depressive patients before and after a series of ECT. Results: Data from 21 studies (543 depressed patients) were analysed, including 6 studies (118 patients) on hippocampal subfields. Meta-analyses could be carried out for seven brain regions for which data from at least three published studies was available. We observed increases in left and right hippocampi, amygdalae, cornua ammonis (CA) 1, CA 2/3, dentate gyri (DG) and subicula with standardized mean change scores ranging between 0.34 and 1.15. The model did not reveal significant volume increases in the caudate. Meta-regression indicated a negative relationship between the reported increases in the DG and relative symptom improvement (−0.27 (SE: 0.09) per 10%). Conclusions: ECT is accompanied by significant volume increases in the bilateral hippocampus and amygdala that are not associated with treatment outcome. Among hippocampal subfields, the most robust volume increases after ECT were measured in the dentate gyrus. The indicated negative correlation of this effect with antidepressant efficacy warrants replication in data of individual patients.
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