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Magnetic seizure therapy reduces suicidal ideation and produces neuroplasticity in treatment-resistant depression
Abstract
Therapeutic
seizures may work for treatment-resistant depression (TRD) by producing
neuroplasticity. We evaluated whether magnetic seizure therapy (MST)
produces changes in suicidal ideation and neuroplasticity as indexed
through transcranial magnetic stimulation and electroencephalography
(TMS-EEG) of the dorsolateral prefrontal cortex (DLPFC). Twenty-three
patients with TRD were treated with MST. Changes in suicidal ideation
was assessed through the Scale for Suicidal Ideation (SSI). Before and
after the treatment course, neuroplasticity in excitatory and inhibitory
circuits was assessed with TMS-EEG measures of cortical-evoked activity
(CEA) and long-interval cortical inhibition (LICI) from the left DLPFC,
and the left motor cortex as a control condition. As in our previous
report, the relationship between TMS-EEG measures and suicidal ideation
was examined with the SSI. Results show that 44.4% of patients
experienced resolution of suicidal ideation. Based on DLPFC assessment,
MST produced significant CEA increase over the frontal central
electrodes (cluster p < 0.05), but did not change LICI on a group level. MST also reduced the SSI scores (p < 0.005)
and the amount of reduction correlated with the decrease in LICI over
the right frontal central electrodes (cluster p < 0.05;
rho = 0.73 for Cz). LICI change identified patients who were resolved of
suicidal ideation with 90% sensitivity and 88% specificity (AUC = 0.9, p = 0.004).
There was no significant finding with motor cortex assessment. Overall,
MST produced significant rates of resolution of suicidal ideation. MST
also produced neuroplasticity in the frontal cortex, likely through
long-term potentiation (LTP)-like mechanisms. The largest reduction in
suicidal ideation was demonstrated in patients showing concomitant
decreases in cortical inhibition—a mechanism linked to enhanced LTP-like
plasticity. These findings provide insights into the mechanisms through
which patients experience resolution of suicidal ideation following
seizure treatments in depression.
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