Modifications structuro-fonctionnelles cérébrales chez des sujets dépressifs sévères avant et après traitement par électroconvulsivothérapie : étude exploratoire ECTIM

Abstract : Background: Electroconvulsive Therapy (ECT) is a non-pharmacological treatment of resistant depressive disorder. Although its efficacy has been demonstrated in this indication, the brain mechanisms underlying this process remain very imprecise. There is currently no work studying the effect of one effective ECT on cerebral structural changes. It seems essential to continue the study of the early and late neuroanatomical correlates underlying neurofunctional processes responsible for improving the clinic. Methods: This is a mono-centric study conducted on the Toulouse University Hospital. In patients with resistant depressive disorder, clinical and multimodal MRI assessments are performed at 4-step intervals. The first evaluation takes place before the beginning of the treatment, the 2nd after a 1st ECT, the 3rd after a 1st effective ECT and the 4th after remission. Results: Regarding the volume of the hippocampus and amygdala at the first visit was not different from the volume at the third visit (t (135) = .329, p = .94). On the contrary, there was a significant difference between the volume of two structures between the first and the fourth visit (t (135) = -2.47, p = .039) and between the third and fourth visits (t (135) = -3.51, p = .002). For mean diffusivity, the effect of visits showed a trend toward significance for MD (F (2.136) = 2.67, p = .072). In the MRI resting state, there is early hypoconnectivity between (i) the right hippocampus and the dorsal anterior cingulate cortex (t = -6.20, pFDR: 0.0123); (ii) right hippocampus and left caudate nucleus (t = -7.69, pFDR: 0.0035) and (iii) vermis cerebellum and precuneus (t = -5.93 p FDR: 0.0363). There is hyperconnectivity between V4 and V1 between (i) the right medial orbit frontal cortex and the medial occipital gyrus (t = 6.58; p FDR: 0.0146) and (ii) the right inferior frontal gyrus and left fronto medial cortex (t = 6.83, pFDR: 0.0104). There is a significant decrease in the symptoms of depression between V4 and V1 at the Hamilton scale (V4: 3.08 AND: 1.62, V1: 23.17 AND: 3.21, p <0.001). Conclusion: There appears to be structural-functional changes at the end of the ECT course. However, we do not find early structural and micro structural changes.
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Antoine Yrondi. Modifications structuro-fonctionnelles cérébrales chez des sujets dépressifs sévères avant et après traitement par électroconvulsivothérapie : étude exploratoire ECTIM. Neurosciences. Université Paul Sabatier - Toulouse III, 2018. Français. ⟨NNT : 2018TOU30062⟩. ⟨tel-02274767⟩

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