Towards a Network Control Theory of Electroconvulsive Therapy Response
Abstract
Electroconvulsive Therapy (ECT) is arguably the most effective intervention for treatment-resistant depression. While large interindividual variability exists, a theory capable of predicting individual response to ECT remains elusive. To address this, we posit a quantitative, mechanistic framework of ECT response based on Network Control Theory (NCT). Then, we empirically test our approach and employ it to predict ECT treatment response. To this end, we derive a formal association between Postictal Suppression Index (PSI) - an ECT seizure quality index - and whole-brain modal and average controllability, NCT metrics based on white matter brain network architecture, respectively. Exploiting the known association of ECT response and PSI, we then hypothesized an association between our controllability metrics and ECT response mediated by PSI. We formally tested this conjecture in N=50 depressive patients undergoing ECT. We show that whole-brain controllability metrics based on pre-ECT structural connectome data predict ECT response in accordance with our hypotheses. In addition, we show the expected mediation effects via PSI. Importantly, our theoretically motivated metrics are at least on par with extensive machine learning models based on pre-ECT connectome data. In summary, we derived and tested a control-theoretic framework capable of predicting ECT response based on individual brain network architecture. It makes testable, quantitative predictions regarding individual therapeutic response, which are corroborated by strong empirical evidence. Our work might constitute a starting point for a comprehensive, quantitative theory of personalized ECT interventions rooted in control theory.
Keywords
Cite
@article{arxiv.2112.07408,
title = {Towards a Network Control Theory of Electroconvulsive Therapy Response},
author = {Tim Hahn and Hamidreza Jamalabadi and Erfan Nozari and Nils R. Winter and Jan Ernsting and Marius Gruber and Marco J. Mauritz and Pascal Grumbach and Lukas Fisch and Ramona Leenings and Kelvin Sarink and Julian Blanke and Leon Kleine Vennekate and Daniel Emden and Nils Opel and Dominik Grotegerd and Verena Enneking and Susanne Meinert and Tiana Borgers and Melissa Klug and Elisabeth J. Leehr and Katharina Dohm and Walter Heindel and Joachim Gross and Udo Dannlowski and Ronny Redlich and Jonathan Repple},
journal= {arXiv preprint arXiv:2112.07408},
year = {2021}
}