Volume of the human hippocampus and clinical response following electroconvulsive therapy

Leif Oltedal*, Katherine L. Narr, Christopher Abbott, Amit Anand, Miklos Argyelan, Hauke Bartsch, Udo Dannlowski, Annemieke Dols, Philip van Eijndhoven, Louise Emsell, Vera Jane Erchinger, Randall Espinoza, Tim Hahn, Lars G. Hanson, Gerhard Hellemann, Martin Balslev Jorgensen, Ute Kessler, Mardien L. Oudega, Olaf B. Paulson, Ronny Redlich & 6 others Pascal Sienaert, Max L. Stek, Indira Tendolkar, Mathieu Vandenbulcke, Ketil J. Oedegaard, Anders M. Dale

*Corresponding author for this work

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Abstract

Background: Hippocampal enlargements are commonly reported following electroconvulsive therapy (ECT). To clarify mechanisms, we examined if ECT induced hippocampal volume change relates to dose (number of ECT sessions and electrode placement) and acts as a biomarker of clinical outcome. Methods: Longitudinal neuroimaging and clinical data from ten independent sites participating in the Global ECT-MRI Research Collaboration were obtained for mega analysis. Hippocampal volumes were extracted from structural MR images, acquired before and after patients (n=281) experiencing a major depressive episode completed an ECT treatment series using right unilateral (RUL) and bilateral (BL) stimulation. Untreated non-depressed controls (n=95) were scanned twice. Results: The linear component of hippocampal volume change was 0.28%, 0.08 SE, per ECT session, p<0.001. Volume change varied by electrode placement in the left (BL: 3.3 ± 2.2%, d=1.5; RUL: 1.6 ± 2.1%, d=0.8; p<0.0001), but not the right hippocampus (BL: 3.0 ± 1.7%, d=1.8; RUL: 2.7 ± 2.0%, d=1.4; p=0.36,). Volume change for electrode placement per ECT session varied similarly by hemisphere. Individuals with greater treatment-related volume increases had poorer outcomes (MADRS change -1.0, 0.35 SE, per 1% volume increase, p=0.005), although effects were not significant after controlling for ECT number (slope: -0.69, 0.38 SE, p=0.069). Conclusions: The number of ECT sessions and electrode placement impacts the extent and laterality of hippocampal enlargement, but volume change is not positively associated with clinical outcome. Results suggest the high efficacy of ECT is not explained by hippocampal enlargement, which alone, might not serve as a viable biomarker for treatment outcome.
Original languageEnglish
JournalBiological Psychiatry
Volume84
Issue number8
Pages (from-to)574-581
Number of pages8
ISSN0006-3223
DOIs
Publication statusPublished - 2018

Keywords

  • ECT
  • Brain
  • Depression
  • Neuroimaging
  • Antidepressant response
  • Biomarker

Cite this

Oltedal, L., Narr, K. L., Abbott, C., Anand, A., Argyelan, M., Bartsch, H., ... Dale, A. M. (2018). Volume of the human hippocampus and clinical response following electroconvulsive therapy. Biological Psychiatry, 84(8), 574-581. https://doi.org/10.1016/j.biopsych.2018.05.017
Oltedal, Leif ; Narr, Katherine L. ; Abbott, Christopher ; Anand, Amit ; Argyelan, Miklos ; Bartsch, Hauke ; Dannlowski, Udo ; Dols, Annemieke ; van Eijndhoven, Philip ; Emsell, Louise ; Erchinger, Vera Jane ; Espinoza, Randall ; Hahn, Tim ; Hanson, Lars G. ; Hellemann, Gerhard ; Jorgensen, Martin Balslev ; Kessler, Ute ; Oudega, Mardien L. ; Paulson, Olaf B. ; Redlich, Ronny ; Sienaert, Pascal ; Stek, Max L. ; Tendolkar, Indira ; Vandenbulcke, Mathieu ; Oedegaard, Ketil J. ; Dale, Anders M. / Volume of the human hippocampus and clinical response following electroconvulsive therapy. In: Biological Psychiatry. 2018 ; Vol. 84, No. 8. pp. 574-581.
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title = "Volume of the human hippocampus and clinical response following electroconvulsive therapy",
abstract = "Background: Hippocampal enlargements are commonly reported following electroconvulsive therapy (ECT). To clarify mechanisms, we examined if ECT induced hippocampal volume change relates to dose (number of ECT sessions and electrode placement) and acts as a biomarker of clinical outcome. Methods: Longitudinal neuroimaging and clinical data from ten independent sites participating in the Global ECT-MRI Research Collaboration were obtained for mega analysis. Hippocampal volumes were extracted from structural MR images, acquired before and after patients (n=281) experiencing a major depressive episode completed an ECT treatment series using right unilateral (RUL) and bilateral (BL) stimulation. Untreated non-depressed controls (n=95) were scanned twice. Results: The linear component of hippocampal volume change was 0.28{\%}, 0.08 SE, per ECT session, p<0.001. Volume change varied by electrode placement in the left (BL: 3.3 ± 2.2{\%}, d=1.5; RUL: 1.6 ± 2.1{\%}, d=0.8; p<0.0001), but not the right hippocampus (BL: 3.0 ± 1.7{\%}, d=1.8; RUL: 2.7 ± 2.0{\%}, d=1.4; p=0.36,). Volume change for electrode placement per ECT session varied similarly by hemisphere. Individuals with greater treatment-related volume increases had poorer outcomes (MADRS change -1.0, 0.35 SE, per 1{\%} volume increase, p=0.005), although effects were not significant after controlling for ECT number (slope: -0.69, 0.38 SE, p=0.069). Conclusions: The number of ECT sessions and electrode placement impacts the extent and laterality of hippocampal enlargement, but volume change is not positively associated with clinical outcome. Results suggest the high efficacy of ECT is not explained by hippocampal enlargement, which alone, might not serve as a viable biomarker for treatment outcome.",
keywords = "ECT, Brain, Depression, Neuroimaging, Antidepressant response, Biomarker",
author = "Leif Oltedal and Narr, {Katherine L.} and Christopher Abbott and Amit Anand and Miklos Argyelan and Hauke Bartsch and Udo Dannlowski and Annemieke Dols and {van Eijndhoven}, Philip and Louise Emsell and Erchinger, {Vera Jane} and Randall Espinoza and Tim Hahn and Hanson, {Lars G.} and Gerhard Hellemann and Jorgensen, {Martin Balslev} and Ute Kessler and Oudega, {Mardien L.} and Paulson, {Olaf B.} and Ronny Redlich and Pascal Sienaert and Stek, {Max L.} and Indira Tendolkar and Mathieu Vandenbulcke and Oedegaard, {Ketil J.} and Dale, {Anders M.}",
year = "2018",
doi = "10.1016/j.biopsych.2018.05.017",
language = "English",
volume = "84",
pages = "574--581",
journal = "Biological Psychiatry",
issn = "0006-3223",
publisher = "Elsevier",
number = "8",

}

Oltedal, L, Narr, KL, Abbott, C, Anand, A, Argyelan, M, Bartsch, H, Dannlowski, U, Dols, A, van Eijndhoven, P, Emsell, L, Erchinger, VJ, Espinoza, R, Hahn, T, Hanson, LG, Hellemann, G, Jorgensen, MB, Kessler, U, Oudega, ML, Paulson, OB, Redlich, R, Sienaert, P, Stek, ML, Tendolkar, I, Vandenbulcke, M, Oedegaard, KJ & Dale, AM 2018, 'Volume of the human hippocampus and clinical response following electroconvulsive therapy', Biological Psychiatry, vol. 84, no. 8, pp. 574-581. https://doi.org/10.1016/j.biopsych.2018.05.017

Volume of the human hippocampus and clinical response following electroconvulsive therapy. / Oltedal, Leif; Narr, Katherine L.; Abbott, Christopher; Anand, Amit; Argyelan, Miklos; Bartsch, Hauke; Dannlowski, Udo; Dols, Annemieke; van Eijndhoven, Philip; Emsell, Louise; Erchinger, Vera Jane; Espinoza, Randall; Hahn, Tim; Hanson, Lars G. ; Hellemann, Gerhard; Jorgensen, Martin Balslev; Kessler, Ute; Oudega, Mardien L.; Paulson, Olaf B.; Redlich, Ronny; Sienaert, Pascal; Stek, Max L.; Tendolkar, Indira; Vandenbulcke, Mathieu; Oedegaard, Ketil J.; Dale, Anders M.

In: Biological Psychiatry, Vol. 84, No. 8, 2018, p. 574-581.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Volume of the human hippocampus and clinical response following electroconvulsive therapy

AU - Oltedal, Leif

AU - Narr, Katherine L.

AU - Abbott, Christopher

AU - Anand, Amit

AU - Argyelan, Miklos

AU - Bartsch, Hauke

AU - Dannlowski, Udo

AU - Dols, Annemieke

AU - van Eijndhoven, Philip

AU - Emsell, Louise

AU - Erchinger, Vera Jane

AU - Espinoza, Randall

AU - Hahn, Tim

AU - Hanson, Lars G.

AU - Hellemann, Gerhard

AU - Jorgensen, Martin Balslev

AU - Kessler, Ute

AU - Oudega, Mardien L.

AU - Paulson, Olaf B.

AU - Redlich, Ronny

AU - Sienaert, Pascal

AU - Stek, Max L.

AU - Tendolkar, Indira

AU - Vandenbulcke, Mathieu

AU - Oedegaard, Ketil J.

AU - Dale, Anders M.

PY - 2018

Y1 - 2018

N2 - Background: Hippocampal enlargements are commonly reported following electroconvulsive therapy (ECT). To clarify mechanisms, we examined if ECT induced hippocampal volume change relates to dose (number of ECT sessions and electrode placement) and acts as a biomarker of clinical outcome. Methods: Longitudinal neuroimaging and clinical data from ten independent sites participating in the Global ECT-MRI Research Collaboration were obtained for mega analysis. Hippocampal volumes were extracted from structural MR images, acquired before and after patients (n=281) experiencing a major depressive episode completed an ECT treatment series using right unilateral (RUL) and bilateral (BL) stimulation. Untreated non-depressed controls (n=95) were scanned twice. Results: The linear component of hippocampal volume change was 0.28%, 0.08 SE, per ECT session, p<0.001. Volume change varied by electrode placement in the left (BL: 3.3 ± 2.2%, d=1.5; RUL: 1.6 ± 2.1%, d=0.8; p<0.0001), but not the right hippocampus (BL: 3.0 ± 1.7%, d=1.8; RUL: 2.7 ± 2.0%, d=1.4; p=0.36,). Volume change for electrode placement per ECT session varied similarly by hemisphere. Individuals with greater treatment-related volume increases had poorer outcomes (MADRS change -1.0, 0.35 SE, per 1% volume increase, p=0.005), although effects were not significant after controlling for ECT number (slope: -0.69, 0.38 SE, p=0.069). Conclusions: The number of ECT sessions and electrode placement impacts the extent and laterality of hippocampal enlargement, but volume change is not positively associated with clinical outcome. Results suggest the high efficacy of ECT is not explained by hippocampal enlargement, which alone, might not serve as a viable biomarker for treatment outcome.

AB - Background: Hippocampal enlargements are commonly reported following electroconvulsive therapy (ECT). To clarify mechanisms, we examined if ECT induced hippocampal volume change relates to dose (number of ECT sessions and electrode placement) and acts as a biomarker of clinical outcome. Methods: Longitudinal neuroimaging and clinical data from ten independent sites participating in the Global ECT-MRI Research Collaboration were obtained for mega analysis. Hippocampal volumes were extracted from structural MR images, acquired before and after patients (n=281) experiencing a major depressive episode completed an ECT treatment series using right unilateral (RUL) and bilateral (BL) stimulation. Untreated non-depressed controls (n=95) were scanned twice. Results: The linear component of hippocampal volume change was 0.28%, 0.08 SE, per ECT session, p<0.001. Volume change varied by electrode placement in the left (BL: 3.3 ± 2.2%, d=1.5; RUL: 1.6 ± 2.1%, d=0.8; p<0.0001), but not the right hippocampus (BL: 3.0 ± 1.7%, d=1.8; RUL: 2.7 ± 2.0%, d=1.4; p=0.36,). Volume change for electrode placement per ECT session varied similarly by hemisphere. Individuals with greater treatment-related volume increases had poorer outcomes (MADRS change -1.0, 0.35 SE, per 1% volume increase, p=0.005), although effects were not significant after controlling for ECT number (slope: -0.69, 0.38 SE, p=0.069). Conclusions: The number of ECT sessions and electrode placement impacts the extent and laterality of hippocampal enlargement, but volume change is not positively associated with clinical outcome. Results suggest the high efficacy of ECT is not explained by hippocampal enlargement, which alone, might not serve as a viable biomarker for treatment outcome.

KW - ECT

KW - Brain

KW - Depression

KW - Neuroimaging

KW - Antidepressant response

KW - Biomarker

U2 - 10.1016/j.biopsych.2018.05.017

DO - 10.1016/j.biopsych.2018.05.017

M3 - Journal article

VL - 84

SP - 574

EP - 581

JO - Biological Psychiatry

JF - Biological Psychiatry

SN - 0006-3223

IS - 8

ER -