Biophysical mechanisms of electroconvulsive therapy-induced volume expansion in the medial temporal lobe: A longitudinal in vivo human imaging study

Akihiro Takamiya, Filip Bouckaert, Maarten Laroy, Jeroen Blommaert, Ahmed Radwan, Ahmad Khatoun, Zhi De Deng, Myles Mc Laughlin, Wim Van Paesschen, François Laurent De Winter, Jan Van den Stock, Stefan Sunaert, Pascal Sienaert, Mathieu Vandenbulcke, Louise Emsell

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Background: Electroconvulsive therapy (ECT) applies electric currents to the brain to induce seizures for therapeutic purposes. ECT increases gray matter (GM) volume, predominantly in the medial temporal lobe (MTL). The contribution of induced seizures to this volume change remains unclear. Methods: T1-weighted structural MRI was acquired from thirty patients with late-life depression (mean age 72.5 ± 7.9 years, 19 female), before and one week after one course of right unilateral ECT. Whole brain voxel-/deformation-/surface-based morphometry analyses were conducted to identify tissue-specific (GM, white matter: WM), and cerebrospinal fluid (CSF) and cerebral morphometry changes following ECT. Whole-brain voxel-wise electric field (EF) strength was estimated to investigate the association of EF distribution and regional brain volume change. The association between percentage volume change in the right MTL and ECT-related parameters (seizure duration, EF, and number of ECT sessions) was investigated using multiple regression. Results: ECT induced widespread GM volume expansion with corresponding contraction in adjacent CSF compartments, and limited WM change. The regional EF was strongly correlated with the distance from the electrodes, but not with regional volume change. The largest volume expansion was identified in the right MTL, and this was correlated with the total seizure duration. Conclusions: Right unilateral ECT induces widespread, bilateral regional volume expansion and contraction, with the largest change in the right MTL. This dynamic volume change cannot be explained by the effect of electrical stimulation alone and is related to the cumulative effect of ECT-induced seizures.

Original languageEnglish
Pages (from-to)1038-1047
Number of pages10
JournalBrain Stimulation
Issue number4
Publication statusPublished - 2021 Jul 1
Externally publishedYes


  • Electric field
  • Electroconvulsive therapy
  • Medial temporal lobe
  • Morphometry analysis
  • Seizure

ASJC Scopus subject areas

  • General Neuroscience
  • Biophysics
  • Clinical Neurology


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