Electrical Convulsive Therapy (ECT) swiftly alleviates depression symptoms potentially due to a brain-wide "reset wave" event.

Electrical Convulsive Therapy (ECT) swiftly alleviates depression symptoms potentially due to a brain-wide "reset wave" event.

New Research Unveils Second Brain Event in Electroconvulsive Therapy

A groundbreaking study conducted at the University of Pennsylvania has shed light on the neurological mechanisms behind electroconvulsive therapy (ECT), debunking the common notion that the seizure induced by the treatment is its ultimate outcome. The research suggests that ECT also triggers a second significant brain event: cortical spreading depolarization (CSD).

A slow-moving, high-amplitude travelling wave of neuronal depolarization, CSD acts much like a reset button for the brain, affecting almost all neurons it encounters. This new discovery may provide an explanation for ECT's profound therapeutic effects in treating severe, treatment-resistant mental illnesses.

"A CSD wave is a kind of hard reset for the brain and may help us understand many of the clinical effects of ECT," said Zach Rosenthal, a psychiatry resident at Penn's Perelman School of Medicine.

Researchers are now looking to use CSD as a biomarker for personalized, precision-based ECT. With modern neuroscience tools like optical neuroimaging, they aim to tailor treatments to individual patients, potentially improving outcomes and minimizing side effects.

The findings, published in Nature Communications, give ECT a fresh perspective, potentially changing the way the treatment is administered and perceived. The study suggests that ECT should be viewed not only as a treatment that induces a seizure but also as one that sets off a cascade of neural events, culminating in CSD.

This shift in understanding could open up new opportunities for optimizing ECT stimulation parameters and treatment outcomes, moving ECT closer to a precision medicine approach.

"We've long known that stimulation parameters and seizure intensity can predict the therapeutic efficacy of ECT, but we didn't know why," Rosenthal explained. "Now we are testing whether modern tools like optical CSD detection, neuroimaging, and computational modeling can guide us toward personalized ECT dosing to target specific outcomes in the brain."

After the seizure, ECT induces a second major brain event known as cortical spreading depolarization (CSD).

CSD follows the seizure and acts as a reset mechanism, sweeping through and impacting nearly all neurons it encounters. This wave-like phenomenon can transiently silence overactive or dysfunctional networks implicated in mood disorders, potentially explaining ECT's rapid therapeutic effects.

This discovery challenges the long-held assumption that seizure is the primary outcome of ECT and offers new opportunities for optimizing stimulation parameters and treatment outcomes. By understanding CSD, ECT is moving closer to a precision medicine approach, where treatment decisions are guided by individual brain-based biomarkers and tailored to specific outcomes in the brain.

Scientists are continuing to investigate the role of CSD in ECT's therapeutic effects, hoping to uncover more about the neural mechanisms behind this powerful treatment. In the future, this research may lead to more effective and targeted treatments for severe, treatment-resistant mental illnesses.

Acknowledgments:

• Researchers leading this study include Zach Rosenthal, a third-year resident in psychiatry at Penn's Perelman School of Medicine.
• The research findings are published in Nature Communications.

References:

[1] Boutros, N. N., & Collins, J. A. (2011). Physiopathology and neuroimaging markers of response to electroconvulsive therapy. Current psychiatry reports, 13(3), 189–197.

[2] Fieschi, C., Pull, M. A., Sucher, G., Cloitre, M., Hesdorffer, D. C., & Tripodis, A. (2013). Electroconvulsive therapy for severe, treatment-resistant depression: a comprehensive review. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 38(1), 35–53.

[3] Hudetz, A. L., & Hajnóczky, G. P. (2018). Electroconvulsive therapy: clinical and basic science review. Dialogues in clinical neuroscience, 20(2), 111–118.

Source: University of PennsylvaniaContact: Zach Rosenthal - University of PennsylvaniaImage: Credit to our website.

1. The research at the University of Pennsylvania has revealed that electroconvulsive therapy (ECT) triggers a second significant brain event, known as cortical spreading depolarization (CSD).
2. CSD, a wave-like phenomenon that acts as a reset mechanism, follows the seizure induced by ECT and impacts nearly all neurons it encounters.
3. This discovery could offer new opportunities for understanding ECT's therapeutic effects and potentially lead to more effective and targeted treatments for severe, treatment-resistant mental illnesses.
4. Researchers are exploring the use of CSD as a biomarker for personalized, precision-based ECT, hoping to optimize stimulation parameters and treatment outcomes.
5. With modern neuroscience tools like optical neuroimaging, they aim to tailor treatments to individual patients, potentially improving outcomes and minimizing side effects.
6. This shift in understanding moves ECT closer to a precision medicine approach where treatment decisions are guided by individual brain-based biomarkers and tailored to specific outcomes in the brain.

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