TY - JOUR
T1 - Central-positive complexes in ECT-induced seizures
T2 - Possible evidence for thalamocortical mechanisms
AU - Huels, Emma R.
AU - Kafashan, Mohammad Mehdi
AU - Hickman, L. Brian
AU - Ching, Shi Nung
AU - Lin, Nan
AU - Lenze, Eric J.
AU - Farber, Nuri B.
AU - Avidan, Michael S.
AU - Hogan, R. Edward
AU - Palanca, Ben Julian A.
N1 - Funding Information:
Research reported in this publication was supported by James S. McDonnell Foundation (MSA, BJAP). We also appreciate funding by the McDonnell Center for Systems Neuroscience (MK, NBF, BJAP). Research reported in this publication was supported by the Washington University Center for Perioperative Mental Health grant number P50 MH122351 (MSA and EJL) from the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH), NIMH grant U01 MH128483 (BJAP), and NIMH K01 MH128663 (MK). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.
Funding Information:
We thank George Mashour, M.D. Ph.D. and Max Kelz, M.D. Ph.D. for their support of the Reconstitution of Consciousness and Cognition Phase 2 (RCC2) Research Collaborative. Their suggestions strengthened this manuscript. We thank members of our team for early discussions and data collection: Dr. Mathias Basner, Hannah Maybrier, Angela Mickle, Sherry McKinnon, Jordan Oberhaus, J. Wylie Spencer, Dr. Troy Wildes, Jamila Burton, Amil Patel, Ginika Apakama, Ravi Upadhyayula, Alaira Lourido, Dr. Changwei Wei, and Chloe Stallion. Kristopher Bakos and Kathryn Vehe Pharm D provided valuable support from Barnes-Jewish Hospital Interventional Pharmacy. Indispensable assistance was provided by Drs. Michael Jarvis and Donald Bohnenkamp, as well as the nursing staff at the Barnes-Jewish Hospital ECT Suite. Research reported in this publication was supported by James S. McDonnell Foundation (MSA, BJAP). We also appreciate funding by the McDonnell Center for Systems Neuroscience (MK, NBF, BJAP). Research reported in this publication was supported by the Washington University Center for Perioperative Mental Health grant number P50 MH122351 (MSA and EJL) from the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH), NIMH grant U01 MH128483 (BJAP), and NIMH K01 MH128663 (MK). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH. The authors report no competing interests.
Publisher Copyright:
© 2022 International Federation of Clinical Neurophysiology
PY - 2023/2
Y1 - 2023/2
N2 - Objective: Central-positive complexes (CPCs) are elicited during electroconvulsive therapy (ECT) as generalized high-amplitude waveforms with maximum positive voltage over the vertex. While these complexes have been qualitatively assessed in previous literature, quantitative analyses are lacking. This study aims to characterize CPCs across temporal, spatial, and spectral domains. Methods: High-density 64-electrode electroencephalogram (EEG) recordings during 50 seizures acquired from 11 patients undergoing right unilateral ECT allowed for evaluation of spatiotemporal characteristics of CPCs via source localization and spectral analysis. Results: Peak-amplitude CPC scalp topology was consistent across seizures, showing maximal positive polarity over the midline fronto-central region and maximal negative polarity over the suborbital regions. The sources of these peak potentials were localized to the bilateral medial thalamus and cingulate cortical regions. Delta, beta, and gamma oscillations were correlated with the peak amplitude of CPCs during seizures induced during ketamine, whereas delta and gamma oscillations were associated with CPC peaks during etomidate anesthesia (excluding the dose-charge titration). Conclusions: Our findings demonstrate the consistency of CPC presence across participant, stimulus charge, time, and anesthetic agent, with peaks localized to bilateral medial thalamus and cingulate cortical regions and associated with delta, beta, and gamma band oscillations (depending on the anesthetic condition). Significance: The consistency and reproducibility of CPCs offers ECT as a new avenue for studying the dynamics of generalized seizure activity and thalamocortical networks.
AB - Objective: Central-positive complexes (CPCs) are elicited during electroconvulsive therapy (ECT) as generalized high-amplitude waveforms with maximum positive voltage over the vertex. While these complexes have been qualitatively assessed in previous literature, quantitative analyses are lacking. This study aims to characterize CPCs across temporal, spatial, and spectral domains. Methods: High-density 64-electrode electroencephalogram (EEG) recordings during 50 seizures acquired from 11 patients undergoing right unilateral ECT allowed for evaluation of spatiotemporal characteristics of CPCs via source localization and spectral analysis. Results: Peak-amplitude CPC scalp topology was consistent across seizures, showing maximal positive polarity over the midline fronto-central region and maximal negative polarity over the suborbital regions. The sources of these peak potentials were localized to the bilateral medial thalamus and cingulate cortical regions. Delta, beta, and gamma oscillations were correlated with the peak amplitude of CPCs during seizures induced during ketamine, whereas delta and gamma oscillations were associated with CPC peaks during etomidate anesthesia (excluding the dose-charge titration). Conclusions: Our findings demonstrate the consistency of CPC presence across participant, stimulus charge, time, and anesthetic agent, with peaks localized to bilateral medial thalamus and cingulate cortical regions and associated with delta, beta, and gamma band oscillations (depending on the anesthetic condition). Significance: The consistency and reproducibility of CPCs offers ECT as a new avenue for studying the dynamics of generalized seizure activity and thalamocortical networks.
KW - Brain stimulation
KW - Electroconvulsive therapy
KW - Electroencephalography
KW - Generalized seizure
KW - Major depressive disorder
KW - Thalamocortical network
UR - http://www.scopus.com/inward/record.url?scp=85144411211&partnerID=8YFLogxK
U2 - 10.1016/j.clinph.2022.11.015
DO - 10.1016/j.clinph.2022.11.015
M3 - Article
C2 - 36549264
AN - SCOPUS:85144411211
SN - 1388-2457
VL - 146
SP - 77
EP - 86
JO - Clinical Neurophysiology
JF - Clinical Neurophysiology
ER -