Development of a Computational Model For ECT Stimulation Titration.

Electroconvulsive Therapy (ECT) is an effective treatment for treatment-resistant depression and other neurological illnesses. Nevertheless, the precise mechanism by which the dosage and stimulation configuration of ECT induce seizures in the brain remains unknown. Our objective is to create a computational model for ECT titration dosing and determine the relationship between seizure threshold, stimulus dosage, and individual head structure. We use a first-order differential equation combined with realistic head structures from magnetic resonance images of 7 participants. The ECT electric potential distribution was simulated for each head model using the COMSOL 6.1 finite element software. Reasonable predictions were achieved using a simple first-order RC electric circuit, successfully forecasting the seizure threshold for 5 out of 7 participants. Nevertheless, it is notable that one participant was titrated for a much longer period, potentially triggering an additional inhibitory mechanism not accounted for. The inclusion of non-linear dynamics further enhances predictions. The study revealed a time constant of approximately 0.5-3 seconds, indicating a non-ionic membrane component underlying seizure initiation. More probable mechanisms might be a transient rise in the permeability of the blood-brain barrier or the buildup of neurotransmitters. In conclusion, seizure threshold during ECT titration can be predicted using a finite element head model coupled with first-order dynamics.