Studies of the Effect of ECT on the Brain

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Studies of the Effect of ECT on the Brain

Dr. Charles Kellner says "There are now important carefully controlled studies with MRI brain scans before and after ECT showing conclusively that there is absolutely no structural brain damage." Click here to view the video of him saying this.

These are the studies. Judge for yourself. Are THESE conclusive evidence?

Title	Year	No. of patients	What was tested? Definitions at bottom	Changes?
Cerebral and brain stem changes	1987	14	T1	yes, temp
Effects of ECT on brain structure	1988	9	cortical atrophy/ global comparisons	no acute change
Time course of cerebra	1990	20 (only 13 were fully tested)	T1	yes, temp
Brain anatomic effects	1991	35	brain volume/ global comparison	some, but explained as cerebrovascular disease
Post-ECT increases	1994	6	T2	yes, "significant"

Br J Psychiatry 1987 Jul;151:69-71

Cerebral and brain stem changes after ECT revealed by nuclear magnetic resonance imaging.

Mander AJ, Whitfield A, Kean DM, Smith MA, Douglas RH, Kendell RE

Nuclear magnetic resonance images of the brain were obtained in fourteen patients with major depression during a course of ECT. The T1 relaxation time rose immediately after the fit, reaching a maximum 4-6 h later. The T1 values then returned to their original level; no long-term increase occurred over the course of treatment. These results are consistent with an extensive but temporary breakdown of the blood-brain barrier during ECT.

Am J Psychiatry 1988 Jun;145(6):701-6

Effects of ECT on brain structure: a pilot prospective magnetic resonance imaging study.

Coffey CE, Figiel GS, Djang WT, Sullivan DC, Herfkens RJ, Weiner RD

The authors describe a pilot prospective investigation of the effects of ECT on brain structure using magnetic resonance imaging (MRI). In nine patients with major depression, a course of ECT produced no acute changes in brain structure according to blind raters' assessments of cortical atrophy and global comparison of pre- and post-ECT studies. There were also no significant changes in the ventricle-brain ratios. Pre-ECT brain abnormalities were common in these patients yet were also unaffected by ECT. Future MRI studies of ECT should include more subjects and should address long-term changes and subtle brain abnormalities.

Br J Psychiatry 1990 Apr;156:551-3

Time course of cerebra; magnetic resonance changes after electroconvulsive therapy.

Scott AI, Douglas RH, Whitfield A, Kendell RE

Nuclear magnetic resonance images of the non-dominant cerebral hemisphere were obtained in 20 unipolar depressed patients immediately before and 25 minutes after electroconvulsive therapy (ECT). T1 values rose about 1%. Repeated scanning up to 24 hours after ECT was carried out in 13 of these patients. The greatest change in magnetic resonance images was two hours after ECT, and thereafter images gradually returned to baseline values. There was no correlation between magnetic resonance changes and the time taken to become reorientated after ECT.

Arch Gen Psychiatry 1991 Nov;48(11):1013-21

Brain anatomic effects of electroconvulsive therapy. A prospective magnetic resonance imaging study.

Coffey CE, Weiner RD, Djang WT, Figiel GS, Soady SA, Patterson LJ, Holt PD, Spritzer CE, Wilkinson WE

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To determine prospectively whether electroconvulsive therapy (ECT) produces structural brain changes, 35 inpatients with depression underwent magnetic resonance imaging before and twice after (at 2 to 3 days and at 6 months) completion of a course of brief-pulse, bilateral ECT. The magnetic resonance images were analyzed blindly for evidence of changes in brain structure using two approaches: measurement of regional brain volumes and a pairwise global comparison. Structural brain abnormalities were present in many patients before ECT. The course of ECT produced no acute or delayed (6-month) change in brain structure as measured by alterations of the total volumes of the lateral ventricles, the third ventricle, the frontal lobes, the temporal lobes, or the amygdala-hippocampal complex. In five subjects, the pairwise global comparisons revealed an apparent increase in subcortical hyperintensity, most likely secondary to progression of ongoing cerebrovascular disease during follow-up. Our results confirm and extend previous imaging studies that also found no relationship between ECT and brain damage.

Psychiatry Res 1994 Nov;54(2):177-84

Post-ECT increases in MRI regional T2 relaxation times and their relationship to cognitive side effects: a pilot study.

Diehl DJ, Keshavan MS, Kanal E, Nebes RD, Nichols TE, Gillen JS

This pilot study examined the hypothesis that magnetic resonance imaging T2 relaxation times of specific brain regions increase after electroconvulsive therapy (ECT) and that these increases are related to the cognitive side effects of ECT. Six depressed patients undergoing unilateral ECT were studied. The results demonstrate significant post-ECT T2 increases in the right and left thalamus, and suggest a correlation between regional T2 increase and anterograde memory impairment following ECT. These findings are consistent with a post-ECT increase in brain water content (perhaps secondary to a breakdown of the blood-brain barrier) and suggest that this process may be related to the memory impairment following ECT.

Definitions:

T1: In magnetic resonance, the time for 63% of longitudinal relaxation to occur; the value is a function of magnetic field strength and the chemical environment of the hydrogen nucleus; for protons in fat and in water, in a 1.5T magnet, about 250 msec and 3000 msec respectively. A T1-weighted image will have a bright fat signal.

T2: In magnetic resonance, the time for 63% of transverse relaxation to occur; the value is a function of magnetic field strength and the chemical environment of the hydrogen nucleus; for protons in fat and in water, in a 1.5T magnet, about 60 msec and 250 msec respectively. A T2-weighted image will have a bright water signal.

global: The complete, generalized, overall, or total aspect.

atrophy: A wasting of tissues, organs, or the entire body, as from death and reabsorption of cells, diminished cellular proliferation, decreased cellular volume, pressure, ischemia, malnutrition, lessened function, or hormonal changes. Syn: atrophia.

more on: Memory Loss From ECT | ECT and Brain Damage

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