Table 1.
Single-Photon Computed Tomography (SPECT) and Longitudinal Changes in ECT.
| Author (Year) | n Diagnosis Mean Age (SD) Male/Female Ratio of Responders/Total Medication Status |
Stimulus Delivery Stimulus Waveform Stimulus Intensity (When Reported) Number ECT Sessions (SD) |
Time From ECT Series to Post-ECT Imaging Assessment HC Group: Yes/No |
Image Analysis | Longitudinal Neuroimaging Results |
|---|---|---|---|---|---|
| 99mTc-HMPAO to measure regional cerebral blood flow (rCBF) | |||||
| Awata et al22 (2002) | 9 MDD 63 years (4) 3 male/6 female 9/9 responders (at 14 days post-ECT) Medication was discontinued 3 days prior to the initial imaging assessment |
Bitemporal Sine wave 8 treatments (1) |
14 days (time 2) and 168 days (time 3) HC: yes |
Region of interest with cerebellar uptake normalization and voxel-wise analysis (whole brain) |
ECT time 1 vs time 2 vs time 3: Mean rCBF ratios increased at time 1 to time 2 and time 1 to time 3; in voxel-wise (whole brain) analysis, rCBF increased in posterior cerebral regions (time 1 to time 2 and time 1 to time 3); rCBF decreased in left posterior cortex (time 2 to time 3) ECT time 1 vs HC: Patients had decreased mean rCBF ratios; in voxel-wise analysis, patients had decreased rCBF in the subcallosal cingulate cortex, bilateral orbitofrontal, right insular, and right frontal cortices. ECT time 2 and 3 vs HC: Mean rCBF ratios nor-malized at time 2 and 3; in voxel-wise analysis, the rCBF deficits persisted in the patient group at time 2 and 3 |
| Vangu et al23 (2003) | 13 MDD and bipolar 37 years (12) 4 male/11 female (2 patients excluded from final analysis) 7/13 responders Medication was discontinued (except for lithium) |
Bitemporal Brief pulse 10 treatments (2) |
5 days HC: no | Region of interest with cerebellar uptake normalization | ECT time 1 vs time 2: Increased rCBF ratio in the anterior cingulate and left frontal regions among all patients. Only analysis with responders was not significant |
| Navarro et al24 (2004) | 16 MDD (includes 5 MDD with psychotic features) 73 years (8) 5 male/11 female 16/16 responders Medication was discontinued 10 days prior to the first imaging assessment |
Bitemporal Brief pulse 10 treatments (1) |
365 HC: yes | Region of interest with cerebellar uptake normalization |
ECT time 1 vs time 2: Increased rCBF ratio in bilateral, anterior frontal regions ECT time 1 vs HC: Patients had decreased rCBF ratios in bilateral anterior frontal regions ECT time 2 vs HC: Normalization of rCBF ratios between ECT responders and HC |
| Takano et al25 (2006) | 8 MDD 49 years (16) 5 male/3 female 8/8 responders Patients remained on medication |
Bitemporal Brief pulse Seizure titration method 7 treatments (1) |
5 days (time 2) and 32 days (time 3) HC: yes |
Three-dimensional stereotactic surface projection |
ECT time 1 vs time 2 vs time 3: Increased rCBF in the right medial frontal gyrus (time 1 to time 3, nonsignificant trend from time 2 to time 3) and the right parahippocamapal gyrus (nonsignificant trend from time 1 to time 2); decreased rCBF in the right cuneus (time 1 to time 2) ECT time 1 vs HC: Patients had decreased rCBF in frontal and limbic regions and increased rCBF in the occipital, parietal, and temporal cortices ECT time 2 vs HC: Patients continued to have decreased rCBF in frontal and limbic regions ECT time 3 vs HC: Patient continued to have decreased rCBF in frontal and limbic regions |
| Kohn et al26 (2007) | 8 MDD 68 years (8) 1 male/7 female 7/8 responders Medication was discontinued 14 days prior to the initial imaging assessment |
Bitemporal Brief pulse 2.5 × seizure threshold 10 treatments (2) |
7 days | Voxel-wise analysis (whole brain) |
ECT time 1 vs time 2: Decreased rCBF in the bilateral parietotemproal and cerebellar cortices ECT time 1 vs HC: Patients had decreased rCBF in bilateral frontal, temporal, insular, parietal, and cortical nuclei ECT time 2 vs HC: Patients had decreased rCBF as above and basal ganglia |
| 99mTc-ECD to measure regional cerebral blood flow (rCBF) | |||||
| Segawa et al27 (2006) | 8 MDD; 2 bipolar II 48 years (9) 7 male/3 female 6/10 responders Patients remained on medication |
Bitemporal Sine wave 10 treatments (1) |
11 days HC: no |
Voxel-wise analysis with linear regression to compare changein rCBF and change in HRSD | ECT time 1 vs time 2: Changes in rCBF and change in HRSD were negatively correlated in the left frontopolar gyrus, amygdala, nucleus accumbens, globus pallidus, and superior temporal gyrus (ie, larger decreases in rCBF were associated with larger reductions in HRSD) |
Abbreviations: ECT, electroconvulsive therapy; HC, healthy comparison; HRSD, Hamilton Rating Scale for Depression; MDD, major depressive disorder; SD, standard deviation; 99mTc-HMPAO, technetium-99m-labeled hexamethylpropyleneamine oxime.