MRI characteristics predicting seizure threshold in patients undergoing electroconvulsive therapy: a prospective study

Jeroen A van Waarde, Lucas J B van Oudheusden, Bart A R Tonino, Nic J A van der Wee, Bastiaan Verwey, Rose C van der Mast, Erik J Giltay

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: In electroconvulsive therapy (ECT), the electrical current must pass the scalp, skull, cerebrospinal fluid (CSF) and brain tissues, to sufficiently exceed the seizure threshold (ST).

OBJECTIVE: To investigate the relationship between these anatomical strata of the head and the level of the ST, in both right unilateral (RUL) and bifrontotemporal (BL) ECT.

METHODS: Observational prospective study among 74 mainly depressed patients. STs were measured at the 1st (initial ST), 6th, 12th, 18th and 24th session. MRI scans were acquired before the 1st session. Scalp and skull thickness at electrode sites were measured on T2-weighted images. Volumes of intracranial space (ICV), CSF, gray and white matter, and white matter hyperintensities were estimated using whole brain isovoxel T1-weighted images. Separate multivariate regression analyses for RUL (n = 55) and BL (n = 19) treated groups were used to estimate the predictive values of the MRI variables.

RESULTS: The patients had a mean age of 57.7 ± 14.8 years, and 39% were men. After adjustment for age, gender and ICV, CSF volume strongly and independently predicted initial ST in both RUL (β = 0.31; P = 0.049) and BL ECT (β = 0.64; P = 0.007). Using multilevel regression analysis, CSF volume was associated with ST during the remaining RUL ECT course (β = 0.20; P = 0.02).

CONCLUSIONS: Taking into account the limitations in the titration method and MRI analysis, volume of CSF strongly and independently predicted initial ST. Therefore, the exclusive use of age-based ECT dosing methods may result in suboptimal electrical stimulus dosage in patients with CSF volumes that are not within the average range.

Original languageEnglish
Pages (from-to)607-14
Number of pages8
JournalBrain stimulation
Volume6
Issue number4
DOIs
Publication statusPublished - Jul 2013

Cite this

van Waarde, J. A., van Oudheusden, L. J. B., Tonino, B. A. R., van der Wee, N. J. A., Verwey, B., van der Mast, R. C., & Giltay, E. J. (2013). MRI characteristics predicting seizure threshold in patients undergoing electroconvulsive therapy: a prospective study. Brain stimulation, 6(4), 607-14. https://doi.org/10.1016/j.brs.2012.12.003
van Waarde, Jeroen A ; van Oudheusden, Lucas J B ; Tonino, Bart A R ; van der Wee, Nic J A ; Verwey, Bastiaan ; van der Mast, Rose C ; Giltay, Erik J. / MRI characteristics predicting seizure threshold in patients undergoing electroconvulsive therapy : a prospective study. In: Brain stimulation. 2013 ; Vol. 6, No. 4. pp. 607-14.
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title = "MRI characteristics predicting seizure threshold in patients undergoing electroconvulsive therapy: a prospective study",
abstract = "BACKGROUND: In electroconvulsive therapy (ECT), the electrical current must pass the scalp, skull, cerebrospinal fluid (CSF) and brain tissues, to sufficiently exceed the seizure threshold (ST).OBJECTIVE: To investigate the relationship between these anatomical strata of the head and the level of the ST, in both right unilateral (RUL) and bifrontotemporal (BL) ECT.METHODS: Observational prospective study among 74 mainly depressed patients. STs were measured at the 1st (initial ST), 6th, 12th, 18th and 24th session. MRI scans were acquired before the 1st session. Scalp and skull thickness at electrode sites were measured on T2-weighted images. Volumes of intracranial space (ICV), CSF, gray and white matter, and white matter hyperintensities were estimated using whole brain isovoxel T1-weighted images. Separate multivariate regression analyses for RUL (n = 55) and BL (n = 19) treated groups were used to estimate the predictive values of the MRI variables.RESULTS: The patients had a mean age of 57.7 ± 14.8 years, and 39{\%} were men. After adjustment for age, gender and ICV, CSF volume strongly and independently predicted initial ST in both RUL (β = 0.31; P = 0.049) and BL ECT (β = 0.64; P = 0.007). Using multilevel regression analysis, CSF volume was associated with ST during the remaining RUL ECT course (β = 0.20; P = 0.02).CONCLUSIONS: Taking into account the limitations in the titration method and MRI analysis, volume of CSF strongly and independently predicted initial ST. Therefore, the exclusive use of age-based ECT dosing methods may result in suboptimal electrical stimulus dosage in patients with CSF volumes that are not within the average range.",
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author = "{van Waarde}, {Jeroen A} and {van Oudheusden}, {Lucas J B} and Tonino, {Bart A R} and {van der Wee}, {Nic J A} and Bastiaan Verwey and {van der Mast}, {Rose C} and Giltay, {Erik J}",
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MRI characteristics predicting seizure threshold in patients undergoing electroconvulsive therapy : a prospective study. / van Waarde, Jeroen A; van Oudheusden, Lucas J B; Tonino, Bart A R; van der Wee, Nic J A; Verwey, Bastiaan; van der Mast, Rose C; Giltay, Erik J.

In: Brain stimulation, Vol. 6, No. 4, 07.2013, p. 607-14.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - MRI characteristics predicting seizure threshold in patients undergoing electroconvulsive therapy

T2 - a prospective study

AU - van Waarde, Jeroen A

AU - van Oudheusden, Lucas J B

AU - Tonino, Bart A R

AU - van der Wee, Nic J A

AU - Verwey, Bastiaan

AU - van der Mast, Rose C

AU - Giltay, Erik J

N1 - Copyright © 2013 Elsevier Inc. All rights reserved.

PY - 2013/7

Y1 - 2013/7

N2 - BACKGROUND: In electroconvulsive therapy (ECT), the electrical current must pass the scalp, skull, cerebrospinal fluid (CSF) and brain tissues, to sufficiently exceed the seizure threshold (ST).OBJECTIVE: To investigate the relationship between these anatomical strata of the head and the level of the ST, in both right unilateral (RUL) and bifrontotemporal (BL) ECT.METHODS: Observational prospective study among 74 mainly depressed patients. STs were measured at the 1st (initial ST), 6th, 12th, 18th and 24th session. MRI scans were acquired before the 1st session. Scalp and skull thickness at electrode sites were measured on T2-weighted images. Volumes of intracranial space (ICV), CSF, gray and white matter, and white matter hyperintensities were estimated using whole brain isovoxel T1-weighted images. Separate multivariate regression analyses for RUL (n = 55) and BL (n = 19) treated groups were used to estimate the predictive values of the MRI variables.RESULTS: The patients had a mean age of 57.7 ± 14.8 years, and 39% were men. After adjustment for age, gender and ICV, CSF volume strongly and independently predicted initial ST in both RUL (β = 0.31; P = 0.049) and BL ECT (β = 0.64; P = 0.007). Using multilevel regression analysis, CSF volume was associated with ST during the remaining RUL ECT course (β = 0.20; P = 0.02).CONCLUSIONS: Taking into account the limitations in the titration method and MRI analysis, volume of CSF strongly and independently predicted initial ST. Therefore, the exclusive use of age-based ECT dosing methods may result in suboptimal electrical stimulus dosage in patients with CSF volumes that are not within the average range.

AB - BACKGROUND: In electroconvulsive therapy (ECT), the electrical current must pass the scalp, skull, cerebrospinal fluid (CSF) and brain tissues, to sufficiently exceed the seizure threshold (ST).OBJECTIVE: To investigate the relationship between these anatomical strata of the head and the level of the ST, in both right unilateral (RUL) and bifrontotemporal (BL) ECT.METHODS: Observational prospective study among 74 mainly depressed patients. STs were measured at the 1st (initial ST), 6th, 12th, 18th and 24th session. MRI scans were acquired before the 1st session. Scalp and skull thickness at electrode sites were measured on T2-weighted images. Volumes of intracranial space (ICV), CSF, gray and white matter, and white matter hyperintensities were estimated using whole brain isovoxel T1-weighted images. Separate multivariate regression analyses for RUL (n = 55) and BL (n = 19) treated groups were used to estimate the predictive values of the MRI variables.RESULTS: The patients had a mean age of 57.7 ± 14.8 years, and 39% were men. After adjustment for age, gender and ICV, CSF volume strongly and independently predicted initial ST in both RUL (β = 0.31; P = 0.049) and BL ECT (β = 0.64; P = 0.007). Using multilevel regression analysis, CSF volume was associated with ST during the remaining RUL ECT course (β = 0.20; P = 0.02).CONCLUSIONS: Taking into account the limitations in the titration method and MRI analysis, volume of CSF strongly and independently predicted initial ST. Therefore, the exclusive use of age-based ECT dosing methods may result in suboptimal electrical stimulus dosage in patients with CSF volumes that are not within the average range.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Depressive Disorder, Major/cerebrospinal fluid

KW - Electroconvulsive Therapy/adverse effects

KW - Female

KW - Humans

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Predictive Value of Tests

KW - Prospective Studies

KW - Seizures/cerebrospinal fluid

KW - Treatment Outcome

U2 - 10.1016/j.brs.2012.12.003

DO - 10.1016/j.brs.2012.12.003

M3 - Article

VL - 6

SP - 607

EP - 614

JO - Brain stimulation

JF - Brain stimulation

SN - 1876-4754

IS - 4

ER -