Doctoral research on electroconvulsive therapy with support from FWO-Vlaanderen
Electroconvulsive therapy has been around for nearly a hundred years. But why the therapy works so well remains unclear. Researcher Maarten Laroy puts a new piece of the puzzle around neuroplasticity.
Electroconvulsive therapy (ECT) is a powerful treatment for severe forms of mood disorder or psychosis. 70-80% response and 50-60% remission: those numbers speak for themselves. The figures are even higher in older patients and in the specific condition catatonia.
But why does ECT work, and how exactly? For the time being, science remains groping in the dark there. Some hypotheses are current. One is that ECT causes an increase or growth of neurons in the limbic system, clearing up the mood illness. Results from animal studies already pointed in that direction.
Temporary volume increase
Multiple human studies have shown that ECT increases brain volume, particularly in the hippocampus. This is how geriatric psychiatrist Prof. Dr. Filip Bouckaert proved in his doctoral research a few years ago. This increase in volume may indicate a growth of neurons, but it may also be due to an increase in blood vessels or inflammatory processes.
A recent study by Maarten Laroy, psychologist and doctoral student under the promotor of Professor Bouckaert, now shows that the volume increase in the gray matter is only temporary. “After three to six months, it has faded away. Moreover, there appears to be no correlation between the volume change in the brain and the clinical course of the disease.’
Measurements in living brain
Maarten Laroy also investigated the path of neuroplasticity: an increased production or growth of brain cells through ECT. ‘For this we measure the level of a certain protein – SV2A – which can be found in the synapses. An increase may indicate an increase in synapses, which may insinuate growth in the brain. This research was done with the recently developed 11C-UCB-J radiotracer, a method for measuring synapses in living brains at the molecular level via a PET scan. Until recently, scientists were only dependent on biopsies from deceased patients for measurements at that level.’
Maarten Laroy just presented the results of that research at the annual conference of the Society of Biological Psychiatry at the end of April in San Diego in the United States. ‘They confirm the increase in gray matter volume after ECT, but they did not show a link with changes in synaptic density.’
This puts a new piece in the ECT puzzle. The question of whether there might be an inflammatory process after ECT, and if so whether the cause lies in the electrical pulses themselves or in the provoked convulsion, is now coming to the fore’, concludes Maarten Laroy. ‘Further research needs to be set up for this.’
References
L3D study
Emsell, L., Laroy, M., Van Cauwenberge, M., Vande Casteele, T., Vansteelandt, K., Van Laere, K., Sunaert, S., Van den Stock, J., Bouckaert, F., Vandenbulcke, M. (2021). The Leuven late life depression (L3D) study: PET-MRI biomarkers of pathological brain aging in late-life depression: study protocol. BMC PSYCHIATRY, 21 (1), Art.No. ARTN 64. doi: 10.1186/s12888-021-03063-y Open Access
ECNP study
Laroy, M., Ousdal, OT., Bartsch, H., Van den Stock, J., Sienaert, P., Vandenbulcke, M., Nordanskog, P., Jorgensen, MB., Dols, A., Van Wingen, G., Prudic, J., Bouckaert, F., Oltedal, L., Emsell, L. (2022). Characterizing the course of gray matter volume change from one week to 6 months after electroconvulsive therapy in depressed patients. In: European Neuropsychopharmacology: Volume 1 Supplement 2, (S49-S50). Presented at the European College for Neuropsychopharmacology Congress in Vienna, Austria. doi: 10.1016/j.nsa.2022.100208
ECT – Cognition – Brain Change
Laroy, M., Bouckaert, F., Vansteelandt, K., Obbels, J., Dols, A., Emsell, L., Stek, M., Vandenbulcke, M., Sienaert, P. (2019). Association between hippocampal volume change and change in memory following electroconvulsive therapy in late-life depression. ACTA PSYCHIATRICA SCANDINAVICA, 140 (5), 435-445. doi: 10.1111/acps.13086
SOBP Meeting
Presentation of the PET-MRI study
2023-06-12 18:33:34
#neuroplasticity #follow #ECT
