Change of Cerebral Function Before and After m-ECT in Patients with Mood Disorder

• Published in: 国際生命情報科学会誌 Vol. 36; no. 1; p. 26
• Main Authors: Kimura Mahito, Akiyama Tomomi, Koeda Michihiko, Shimoda Kengo
• Format: Journal Article
• Language: English
• Published: 国際生命情報科学会 2018; International Society of Life Information Science
• Subjects: cerebral function; modified electroconvulsive therapy (m-ECT); mood disorder; near-infrared spectroscopy (NIRS); 修正型電気けいれん療法; 気分障害; 脳機能; 近赤外線スペクトロスコピー
• ISSN: 1341-9226; 2424-0761
• DOI: 10.18936/islis.36.1_26

Background: Near-infrared spectroscopy (NIRS) is used as a clinically convenient application to evaluate pathophysiology in mood disorders. Modified electroconvulsive therapy (m-ECT) is used as one choice of the treatment for severe depression and treatment-resistant depression, but to our knowledge, few studies have investigated the m-ECT effect on cerebral function. Aim: We intended to investigate the therapeutic effect of m-ECT for mood disorders by NIRS. Methods: Based on the approved protocol by the ethics committee, fronto-temporal activity of 13 patients with mood disorders were evaluated during a verbal fluency procedure before and after m-ECT with NIRS. After a complete explanation of the study, written informed consent was obtained from all subjects. Patients with mood disorder were classified into one group with 6 depression patterns (D-pattern group) and a second group with 7 manic-depressive patterns (MDI-pattern group) by the frontal lobe mean oxy-hemoglobin pattern based on a previous NIRS study (Takizawa et al., 2014). Results: Depressed state in all 13 subjects was mitigated after m-ECT. Temporal lobe activity in both D-pattern group and MDI-pattern group significantly increased after m-ECT compared to before m-ECT. Frontal lobe activity in the MDI pattern group was much improved after m-ECT compared to frontal lobe activity in the D-pattern group. In the MDI pattern group, the mean of the frontal lobe activity after m-ECT was significantly greater than before m-ECT at the bilateral middle frontal region and the left orbitofrontal region. Conclusion: Our results suggest that temporal lobe activity increases in both D-pattern group and MDI-pattern group, but the frontal lobe activity increases only in MDI pattern group during the verbal fluency task as seen by NIRS after m-ECT accompanied by mitigation of the depressive state. 背景：近赤外線分光法（NIRS）は、気分障害の病態生理を評価するのに簡便な臨床検査方法である。修正型電気けいれん療法（m-ECT）は、重症うつ病や治療抵抗性うつ病の治療法の1 つとして用いられているが、脳機能に及ぼすm-ECT の効果についてはほとんど研究されていない。目的：我々はNIRS を用いて気分障害に対するm-ECT の治療効果を検討した。方法：倫理委員会に承認された方法に基づいて、13 例の気分障害患者がNIRS を用いてmECT 前後に おいて言語流暢性課題中の脳機能を評価した。研究内容を十分説明し、全ての被験者から書面同意を得た。先行のNIRS 研究（Takizawa et.al, 2014）に前頭葉の酸素化ヘモグロビンの平均パターンよって、6 例のうつ病パターンと7 例の躁うつ病パターンに分類された。結果： 13 例すべての被験者のうつ状態がm-ECT 後に改善された。側頭葉活性は、うつ病パターンと躁うつ病パターンの両方の患者でm-ECT 前に比べてmECT 後に有意に増加した。前頭葉活性は、躁 うつ病パターンがうつ病パターンと比較してm-ECT 後に大幅に改善された。 躁うつ病パターンでは、両側中前頭領域および左眼窩前頭領域でm-ECT 前に比べてm-ECT 後に有意に増加した。結論：我々の結果は、m-ECT 後のうつ状態の改善に伴って、NIRS による言語流暢性課題中の側頭葉活性は、うつ病と躁うつ病パターンの両方の患者で増加するが、前頭葉活性は躁うつ病パターンの患者のみで増加することが示唆された。