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; Pascal Sienaert; Max L Stek; Indira Tendolkar; Mathieu Vandenbulcke; Ketil J Oedegaard; Anders M Dale

doi:10.1016/j.biopsych.2018.05.017

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 RedlichPascal Sienaert, Max L Stek, Indira Tendolkar, Mathieu Vandenbulcke, Ketil J Oedegaard, Anders M Dale

Department of Clinical Medicine

67 Citations (Scopus)

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Abstract

Background: Hippocampal enlargements are commonly reported after 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 10 independent sites participating in the Global ECT-Magnetic Resonance Imaging Research Collaboration (GEMRIC) were obtained for mega-analysis. Hippocampal volumes were extracted from structural magnetic resonance images, acquired before and after patients (n = 281) experiencing a major depressive episode completed an ECT treatment series using right unilateral and bilateral stimulation. Untreated nondepressed control subjects (n = 95) were scanned twice. Results: The linear component of hippocampal volume change was 0.28% (SE 0.08) per ECT session (p <.001). Volume change varied by electrode placement in the left hippocampus (bilateral, 3.3 ± 2.2%, d = 1.5; right unilateral, 1.6 ± 2.1%, d = 0.8; p <.0001) but not the right hippocampus (bilateral, 3.0 ± 1.7%, d = 1.8; right unilateral, 2.7 ± 2.0%, d = 1.4; p =.36). Volume change for electrode placement per ECT session varied similarly by hemisphere. Individuals with greater treatment-related volume increases had poorer outcomes (Montgomery–Åsberg Depression Rating Scale change –1.0 [SE 0.35], per 1% volume increase, p =.005), although the effects were not significant after controlling for ECT number (slope –0.69 [SE 0.38], p =.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. The results suggest that the high efficacy of ECT is not explained by hippocampal enlargement, which alone might not serve as a viable biomarker for treatment outcome.

Original language	English
Journal	Biological Psychiatry
Volume	84
Issue number	8
Pages (from-to)	574-581
Number of pages	8
ISSN	0006-3223
DOIs	https://doi.org/10.1016/j.biopsych.2018.05.017
Publication status	Published - 15 Oct 2018

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Volume of the Human Hippocampus and ClinicalResponse Following Electroconvulsive TherapyFinal published version, 318 KBLicence: CC BY-NC-ND

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Oltedal, L., Narr, K. L., Abbott, C., Anand, A., Argyelan, M., Bartsch, H., Dannlowski, U., Dols, A., van Eijndhoven, P., Emsell, L., Erchinger, V. J., Espinoza, R., Hahn, T., Hanson, L. G., Hellemann, G., Jorgensen, M. B., Kessler, U., Oudega, M. L., Paulson, O. B., ... 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, 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

@article{8d09096a5acc49e0bab23097effc4dc0,

title = "Volume of the Human Hippocampus and Clinical Response Following Electroconvulsive Therapy",

abstract = "Background: Hippocampal enlargements are commonly reported after 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 10 independent sites participating in the Global ECT-Magnetic Resonance Imaging Research Collaboration (GEMRIC) were obtained for mega-analysis. Hippocampal volumes were extracted from structural magnetic resonance images, acquired before and after patients (n = 281) experiencing a major depressive episode completed an ECT treatment series using right unilateral and bilateral stimulation. Untreated nondepressed control subjects (n = 95) were scanned twice. Results: The linear component of hippocampal volume change was 0.28% (SE 0.08) per ECT session (p <.001). Volume change varied by electrode placement in the left hippocampus (bilateral, 3.3 ± 2.2%, d = 1.5; right unilateral, 1.6 ± 2.1%, d = 0.8; p <.0001) but not the right hippocampus (bilateral, 3.0 ± 1.7%, d = 1.8; right unilateral, 2.7 ± 2.0%, d = 1.4; p =.36). Volume change for electrode placement per ECT session varied similarly by hemisphere. Individuals with greater treatment-related volume increases had poorer outcomes (Montgomery–{\AA}sberg Depression Rating Scale change –1.0 [SE 0.35], per 1% volume increase, p =.005), although the effects were not significant after controlling for ECT number (slope –0.69 [SE 0.38], p =.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. The results suggest that the high efficacy of ECT is not explained by hippocampal enlargement, which alone might not serve as a viable biomarker for treatment outcome.",

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",

month = oct,

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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",

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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 - 2018/10/15

Y1 - 2018/10/15

N2 - Background: Hippocampal enlargements are commonly reported after 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 10 independent sites participating in the Global ECT-Magnetic Resonance Imaging Research Collaboration (GEMRIC) were obtained for mega-analysis. Hippocampal volumes were extracted from structural magnetic resonance images, acquired before and after patients (n = 281) experiencing a major depressive episode completed an ECT treatment series using right unilateral and bilateral stimulation. Untreated nondepressed control subjects (n = 95) were scanned twice. Results: The linear component of hippocampal volume change was 0.28% (SE 0.08) per ECT session (p <.001). Volume change varied by electrode placement in the left hippocampus (bilateral, 3.3 ± 2.2%, d = 1.5; right unilateral, 1.6 ± 2.1%, d = 0.8; p <.0001) but not the right hippocampus (bilateral, 3.0 ± 1.7%, d = 1.8; right unilateral, 2.7 ± 2.0%, d = 1.4; p =.36). Volume change for electrode placement per ECT session varied similarly by hemisphere. Individuals with greater treatment-related volume increases had poorer outcomes (Montgomery–Åsberg Depression Rating Scale change –1.0 [SE 0.35], per 1% volume increase, p =.005), although the effects were not significant after controlling for ECT number (slope –0.69 [SE 0.38], p =.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. The results suggest that 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 after 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 10 independent sites participating in the Global ECT-Magnetic Resonance Imaging Research Collaboration (GEMRIC) were obtained for mega-analysis. Hippocampal volumes were extracted from structural magnetic resonance images, acquired before and after patients (n = 281) experiencing a major depressive episode completed an ECT treatment series using right unilateral and bilateral stimulation. Untreated nondepressed control subjects (n = 95) were scanned twice. Results: The linear component of hippocampal volume change was 0.28% (SE 0.08) per ECT session (p <.001). Volume change varied by electrode placement in the left hippocampus (bilateral, 3.3 ± 2.2%, d = 1.5; right unilateral, 1.6 ± 2.1%, d = 0.8; p <.0001) but not the right hippocampus (bilateral, 3.0 ± 1.7%, d = 1.8; right unilateral, 2.7 ± 2.0%, d = 1.4; p =.36). Volume change for electrode placement per ECT session varied similarly by hemisphere. Individuals with greater treatment-related volume increases had poorer outcomes (Montgomery–Åsberg Depression Rating Scale change –1.0 [SE 0.35], per 1% volume increase, p =.005), although the effects were not significant after controlling for ECT number (slope –0.69 [SE 0.38], p =.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. The results suggest that the high efficacy of ECT is not explained by hippocampal enlargement, which alone might not serve as a viable biomarker for treatment outcome.

U2 - 10.1016/j.biopsych.2018.05.017

DO - 10.1016/j.biopsych.2018.05.017

M3 - Journal article

C2 - 30006199

SN - 0006-3223

VL - 84

SP - 574

EP - 581

JO - Biological Psychiatry

JF - Biological Psychiatry

IS - 8

ER -

Volume of the Human Hippocampus and Clinical Response Following Electroconvulsive Therapy

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