Correlating electroconvulsive therapy response to electroencephalographic markers: Study protocol

Subha Subramanian; Alyssa K Labonte; Thomas Nguyen; Anhthi H Luong; Orlandrea Hyche; S Kendall Smith; R Edward Hogan; Nuri B Farber; Ben Julian A Palanca; MohammadMehdi Kafashan; CET-REM Study Group

doi:10.3389/fpsyt.2022.996733

Correlating electroconvulsive therapy response to electroencephalographic markers: Study protocol

Front Psychiatry. 2022 Nov 3:13:996733. doi: 10.3389/fpsyt.2022.996733. eCollection 2022.

Authors

Subha Subramanian^{1

2

3}, Alyssa K Labonte^{4

5}, Thomas Nguyen⁴, Anhthi H Luong^{4

6}, Orlandrea Hyche⁴, S Kendall Smith^{4

7}, R Edward Hogan⁸, Nuri B Farber¹, Ben Julian A Palanca^{1

4

7

9

10

11}, MohammadMehdi Kafashan^{4

7}; CET-REM Study Group

Collaborators

CET-REM Study Group:
Gaurang Gupte, L Brian Hickman, Emma R Huels, Allyson Quigley, Maria Tello Borja

Affiliations

¹ Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States.
² Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, United States.
³ Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States.
⁴ Department of Anesthesiology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States.
⁵ Neuroscience Graduate Program, Washington University School of Medicine in St. Louis, St. Louis, MO, United States.
⁶ Department of Health Policy and Management, Columbia University, New York, NY, United States.
⁷ Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, MO, United States.
⁸ Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States.
⁹ Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, United States.
¹⁰ Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, United States.
¹¹ Neuroimaging Labs Research Center, Washington University School of Medicine in St. Louis, St. Louis, MO, United States.

Abstract

Introduction: Electroconvulsive therapy (ECT) is an effective intervention for patients with major depressive disorder (MDD). Despite longstanding use, the underlying mechanisms of ECT are unknown, and there are no objective prognostic biomarkers that are routinely used for ECT response. Two electroencephalographic (EEG) markers, sleep slow waves and sleep spindles, could address these needs. Both sleep microstructure EEG markers are associated with synaptic plasticity, implicated in memory consolidation, and have reduced expression in depressed individuals. We hypothesize that ECT alleviates depression through enhanced expression of sleep slow waves and sleep spindles, thereby facilitating synaptic reconfiguration in pathologic neural circuits.

Methods: Correlating ECT Response to EEG Markers (CET-REM) is a single-center, prospective, observational investigation. Wireless wearable headbands with dry EEG electrodes will be utilized for at-home unattended sleep studies to allow calculation of quantitative measures of sleep slow waves (EEG SWA, 0.5-4 Hz power) and sleep spindles (density in number/minute). High-density EEG data will be acquired during ECT to quantify seizure markers.

Discussion: This innovative study focuses on the longitudinal relationships of sleep microstructure and ECT seizure markers over the treatment course. We anticipate that the results from this study will improve our understanding of ECT.

Keywords: depression; electroconvulsive therapy (ECT); electroencephalography (EEG); seizure; sleep; sleep spindle; slow wave (NREM) sleep.

Abstract

Grants and funding