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Subramanian S, Labonte AK, Nguyen T, Luong AH, Hyche O, Smith SK, Hogan RE, Farber NB, Palanca BJA, Kafashan M. Correlating electroconvulsive therapy response to electroencephalographic markers: Study protocol. Front Psychiatry 2022; 13:996733. [PMID: 36405897 PMCID: PMC9670172 DOI: 10.3389/fpsyt.2022.996733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/10/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Electroconvulsive therapy (ECT) is an effective intervention for patients with major depressive disorder (MDD). Despite longstanding use, the underlying mechanisms of ECT are unknown, and there are no objective prognostic biomarkers that are routinely used for ECT response. Two electroencephalographic (EEG) markers, sleep slow waves and sleep spindles, could address these needs. Both sleep microstructure EEG markers are associated with synaptic plasticity, implicated in memory consolidation, and have reduced expression in depressed individuals. We hypothesize that ECT alleviates depression through enhanced expression of sleep slow waves and sleep spindles, thereby facilitating synaptic reconfiguration in pathologic neural circuits. Methods Correlating ECT Response to EEG Markers (CET-REM) is a single-center, prospective, observational investigation. Wireless wearable headbands with dry EEG electrodes will be utilized for at-home unattended sleep studies to allow calculation of quantitative measures of sleep slow waves (EEG SWA, 0.5-4 Hz power) and sleep spindles (density in number/minute). High-density EEG data will be acquired during ECT to quantify seizure markers. Discussion This innovative study focuses on the longitudinal relationships of sleep microstructure and ECT seizure markers over the treatment course. We anticipate that the results from this study will improve our understanding of ECT.
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Affiliation(s)
- Subha Subramanian
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Alyssa K. Labonte
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Neuroscience Graduate Program, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Thomas Nguyen
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Anhthi H. Luong
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Health Policy and Management, Columbia University, New York, NY, United States
| | - Orlandrea Hyche
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - S. Kendall Smith
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, MO, United States
| | - R. Edward Hogan
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Nuri B. Farber
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Ben Julian A. Palanca
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, MO, United States
- Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States
- Neuroimaging Labs Research Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - MohammadMehdi Kafashan
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, MO, United States
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Kafashan M, Brian Hickman L, Labonte AK, Huels ER, Maybrier H, Guay CS, Subramanian S, Farber NB, Ching S, Hogan RE, Kelz MB, Avidan MS, Mashour GA, Palanca BJA. Quiescence during burst suppression and postictal generalized EEG suppression are distinct patterns of activity. Clin Neurophysiol 2022; 142:125-132. [PMID: 36030576 PMCID: PMC10287541 DOI: 10.1016/j.clinph.2022.07.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 06/15/2022] [Accepted: 07/17/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Periods of low-amplitude electroencephalographic (EEG) signal (quiescence) are present during both anesthetic-induced burst suppression (BS) and postictal generalized electroencephalographic suppression (PGES). PGES following generalized seizures induced by electroconvulsive therapy (ECT) has been previously linked to antidepressant response. The commonality of quiescence during both BS and PGES motivated trials to recapitulate the antidepressant effects of ECT using high doses of anesthetics. However, there have been no direct electrographic comparisons of these quiescent periods to address whether these are distinct entities. METHODS We compared periods of EEG quiescence recorded from two human studies: BS induced in 29 healthy adult volunteers by isoflurane general anesthesia and PGES in 11 patients undergoing right unilateral ECT for treatment-resistant depression. An automated algorithm allowed detection of EEG quiescence based on a 10-microvolt amplitude threshold. Spatial, spectral, and temporal analyses compared quiescent epochs during BS and PGES. RESULTS The median (interquartile range) voltage for quiescent periods during PGES was greater than during BS (1.81 (0.22) microvolts vs 1.22 (0.33) microvolts, p < 0.001). Relative power was greater for quiescence during PGES than BS for the 1-4 Hz delta band (p < 0.001), at the expense of power in the theta (4-8 Hz, p < 0.001), beta (13-30 Hz, p = 0.04) and gamma (30-70 Hz, p = 0.006) frequency bands. Topographic analyses revealed that amplitude across the scalp was consistently higher for quiescent periods during PGES than BS, whose voltage was within the noise floor. CONCLUSIONS Quiescent epochs during PGES and BS have distinct patterns of EEG signals across voltage, frequency, and spatial domains. SIGNIFICANCE Quiescent epochs during PGES and BS, important neurophysiological markers for clinical outcomes, are shown to have distinct voltage and frequency characteristics.
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Affiliation(s)
- MohammadMehdi Kafashan
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - L Brian Hickman
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Alyssa K Labonte
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Neuroscience Graduate Program, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Emma R Huels
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Hannah Maybrier
- Psychological & Brain Sciences Department, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Christian S Guay
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Picower Institute for Learning & Memory, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Subha Subramanian
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Nuri B Farber
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - ShiNung Ching
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, MO, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - R Edward Hogan
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Max B Kelz
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - George A Mashour
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Ben J A Palanca
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, MO, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
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Pottkämper JCM, Verdijk JPAJ, Hofmeijer J, van Waarde JA, van Putten MJAM. Seizures induced in electroconvulsive therapy as a human epilepsy model: A comparative case study. Epilepsia Open 2021; 6:672-684. [PMID: 34351710 PMCID: PMC8633469 DOI: 10.1002/epi4.12532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/09/2021] [Accepted: 07/30/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Standardized investigation of epileptic seizures and the postictal state may contribute to a better understanding of ictal and postictal phenomena. This comparative case study aims to assess whether electrically induced seizures in electroconvulsive therapy (ECT) show sufficient similarities with spontaneous seizures to serve as a human epilepsy model. METHODS We compared six EEG recordings, three ECT-induced seizures and three generalized tonic-clonic seizures, using quantitative electroencephalography (EEG) analyses. EEG recordings during and after ECT sessions (under general anesthesia and muscle paralysis) were collected prospectively, whereas epilepsy data were selected retrospectively. Time-frequency representations, dominant ictal frequencies, and postictal alpha-delta ratios were calculated. RESULTS In all EEG recordings, a decrease in dominant ictal frequency was observed, as well as postictal suppression. Postictal alpha-delta ratio indicated the same trend for all: a gradual increase from predominantly delta to alpha frequencies on timescales of hours after the seizure. Postictal spectral representation was similar. Muscle artifacts were absent in ECT-induced seizures and present in spontaneous seizures. Ictal amplitude was higher in epileptic than in ECT-induced seizures. Temporospectral ictal dynamics varied slightly between groups. SIGNIFICANCE We show that ictal and postictal characteristics in ECT and patients with generalized tonic-clonic seizures are essentially similar. ECT-induced seizures may be used to investigate aspects of ictal and postictal states in a highly predictable manner and well-controlled environment. This suggests that clinical and electrophysiological observations during ECT may be extrapolated to epilepsy with generalized tonic-clonic seizures.
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Affiliation(s)
- Julia C. M. Pottkämper
- Clinical NeurophysiologyTechnical Medical CentreFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
- Department of PsychiatryRijnstate HospitalArnhemThe Netherlands
- Department of NeurologyRijnstate HospitalArnhemThe Netherlands
| | - Joey P. A. J. Verdijk
- Clinical NeurophysiologyTechnical Medical CentreFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
- Department of PsychiatryRijnstate HospitalArnhemThe Netherlands
| | - Jeannette Hofmeijer
- Clinical NeurophysiologyTechnical Medical CentreFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
- Department of NeurologyRijnstate HospitalArnhemThe Netherlands
| | | | - Michel J. A. M. van Putten
- Clinical NeurophysiologyTechnical Medical CentreFaculty of Science and TechnologyUniversity of TwenteEnschedeThe Netherlands
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