New research from Penn Medicine finds that ECT sets in motion a brain event that resets its neurons, and has the potential to guide personalized ECT dosing to target specific outcomes in the brain.
2 min. read
ECT, or electroconvulsive therapy, uses brief, noninvasive electrical stimulation of the brain to induce a seizure. Despite an outdated pop culture moniker (electroshock therapy) that often paints the treatment in a negative light, ECT has been proven to be a safe and highly effective treatment, offering rapid relief from severe symptoms when medications have failed.
Brain scans showing neuronal fluorescence and hemoglobin absorption.
(Image: Courtesy of Penn Medicine News)
“People don’t think of ECT as ‘modern medicine,’ but it remains the gold standard intervention for treatment-resistant depression, psychosis, catatonia, bipolar mania, and more,” says Zach Rosenthal, a third-year resident in psychiatry at Penn’s Perelman School of Medicine.
Rosenthal is leading a group that published new findings which challenge a long-held assumption that the seizure induced by ECT is the treatment’s ultimate outcome, potentially changing the way the treatment is administered and viewed.
The group’s findings, published in Nature Communications, find that immediately after seizure, ECT induces a second major brain event, known as cortical spreading depolarization (CSD), a slow-moving, high-amplitude traveling wave of neuronal depolarization that resets virtually every neuron in its path.
“A CSD wave is a kind of hard reset for the brain and has the potential to explain many of the clinical effects of ECT,” Rosenthal says.
Using a modern neuroscience tool called optical neuroimaging (a non-invasive tool that uses light to measure brain activity), the team was able to demonstrate that CSD occurs after ECT using specialized tools like optical neuroimaging to detect them.
“ECT is moving toward a precision medicine approach, using brain-based biomarkers to guide individualized treatment decisions,” Rosenthal says. “We’ve known for decades that stimulation parameters and seizure intensity can predict therapeutic efficacy of ECT, but we didn’t know why. Now we are testing whether modern tools like optical CSD detection, neuroimaging, and computational modeling can guide us towards personalized ECT dosing to target specific outcomes in the brain.”
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