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Bilateral near-infrared monitoring of the

cerebral concentration and oxygenation of hemoglobin
. during unilateral electro-convulsive therapy
Sergio Fantini, Francesco Fabbri, Shalini Nadgir
Department ofBiomedica1 Engineering, TUBSUniversity, 4 Colby Street, Medford, MA 02155
sergio.fantini@tu@s.edu

Michael E. Henry, Perry F. Renshaw

McLean Hospital, 115hhll Street, Belmont, MA 02478

Maria Angela Franceschini

Department ofBiomedica1 Engineering, Tups University, 4 Colby Street, Medford, MA 02155
& NMR Center, Massachusetts General Hospital, IS" Street Bldg 149, Charlestown, MA 02129

Abstract: We have measured the changes in the cerebral concentration and oxygen saturation of
hemoglobin with near-infrared spectroscopy on the forehead of ten patients undergoing right
unilateral electro-convulsive therapy (ECT).
02000 Optical Society of America
OClS codes: (170.1610, 170.5270, 170.6510, 170.6930,300.1030)

1. Introduction

Electro-convulsive therapy (ECT) is commonly used for the tteatment of severe and medication-resistant affective
disorders. Under geneml anesthesia, two electrodes placed on the patient's head deliver an electrical current through
the brain that induces a moddied seizure.
We report a near-infrared spectroscopy (NIRS) study performed on ten patients during right unilateral ECT. We
performed bilateral recordings of the concentrations of oxy-hemoglobin ([Hbadeoxy-hemoglobin
]),
(m]),total
hemoglobin (THC), and the cerebml oxygenation ( S O )in the frontal brain regon.
2. Methods

The NIRS instmment is a two-channel frequency-domain tissue spectrometer (OxiplexTS, ISS, Inc., Champaign, E)
operating at two wavelengths (690 and 830 nm). Two optical probes, one per detection channel, are placed on the
right side (ipsilateral to the ECT electrical discharge) and left side (contralateral to the ECT electrical discharge),
respectively, of the patient's forehead. We started the acquisitions of NlRS data about two minutes before the
administration of the electrical discharge for ECT. We continued the NIRS acquisitions through the electricallyinduced seizure and for 20-120 s after the end of the seinire. The protocol for this study was approved by the
Institutional Review Board of McLean Hospital, and all patients gave their written informed consent before
participating in this study.
3. Results
In all the patients, we found a stronger decrease in the cerebral oxygenation on the side ipsilateral to the electrical
discharge with respect to the decrease on the contralateral side. The ipsilateral deoxygenation was -22 f lo%, whde
the contralateml deoxygenation was -6 f 10% (average fstandard deviation over the ten patients). The arterial
saturation, which was recorded with a standard pulse oximeter at the patient's finger, decreased sigrufcantly
(-16 6Yo) in five patients. In the remaining five patients, we did not observe a significant seizure-induced change
in the arterial saturation.
On the ipsilateral side, the THC usually decreases after the ECT discharge. This decrease is -7 k 6 phi (average
k standard deviation over the ten patients). On the other hand, the contralateral THC showed a decrease in four
patients, and ati increase in the remaining six patients. As a result, the overall contralateral change in total
hemoglobin concentration is an increase by 6 k 10 p M (average k standard deviation over the ten patients).
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4. Discussion

We consistently measured a decrease in the cerebral oxygen saturation following the ECT discharge, and the
deoxygenation on the brain side ipsilateral to the ECT mscharge was always greater than the deoxygenation on the
contralateral side. These results indicate the relevance of bilateml measurements in unilateral ECT, and they
demonstrate the regional dependence of the cerebral oxygenation during ECT, so that the systemic oxygenation
monitor provided by pulse oximetq may be insufficientto assess the adequacy of brain oxygenation during ECT.
This latter point is further strengthened by the fact that in five patients we observed a significantcerebral
deoxygenation with NIRS, but negligible arterial desaturation with pulse oximetry.
Another consistent result across the ten patients is the decrease in the cerebral THC on the side ipsilateralto the
ECT electrical discharge. A key point to interpret this result is the behavior of p-IbOZ](decrease) and [Hb] (no
change) during the 3 seconds of ECT discharge. A decrease in D O 2 ]and a concurrent lack of change of [Hb] are
consistent with a vascular contraction (most likely caused by the electrical current through the brain) and a
simultaneous increase in the cerebral metabolic rate of oxygen (caused by the electrically-induced seizure) [ 13. This
observation suggests that the shock-induced vascular contraction may introduce a significant difference between
electrically-induced seizures and spontaneous or chemically-induced seizures. This difference can account for the
observed increase in THC during spontaneous [2-51 or chemically-induced [6] seizures as opposed to the decrease in
THC observed during electrically-induced seizures as reported here and by Saito et a1 [7].

References
[ 11 S.Fantini, A haemodynamic model for the physiological interpretation of in vivo measurements of the concentration and oxygen saturation
of haemoglobin, Phys. Med. Biol. 47, N249-N257 (2002).
[2] A Villringer, J. Planck, S. Stodieck, K. Botzel, L. Schleinkofer, and U. Dimagl, Noninvasive assessment of cerebral hemodynamics and
tissue oxygenation during activation of brain cell function in human adults using near infrared spectroscopy, Adv Exp Med Biol345, 559565 (1994).
[3] B. J. Steinhoff, G. Herrendorf, and C. Kurth, Ictal near infrared spectroscopy in temporal lobe epilepsy: a pilot study, Seizure 5,97-101
(1996).
[4] P. D. Adelson. E. Nemoto, M. Scheuer, M. Painter, J. Morgan, and H. Yonas, Noninvasive Continuous Monitoring of Cerebral Oxygenation
Periictally Using Near-infrared Spectroscopy: a Preliminary Report, Epilepsia 40,1484-1489 (1999).
[5] M. Shichiri, T. Tanabe, K. Hara, S. Suzuki, E. Wakamiya, H. Tamai, Usefnlness of near-infrared spectroscopy for identification of epileptic
foci in two localization-related epilepsy patients, No To Hattatsu 33,475-479 (2001).
[6] E. Watanabe, A. Maki, F. Kawaguchi, Y. Yamashita, H. Koizumi, and Y. Mayanagi, TJoninvasive cerebral blood volume measurement
during seizures using multichannel near infrared spectroscopic topography, J . Biomed. Opt. 5,287-290. (2000).
[I S. Saito, D. Yoshikawa, Y. Nishihara, T. Morita, Y. Kitani, T. Amaya, and T. Fujita, The cerebral hemodynamic response to electrically
induced seizures in man, Brain Res 673,93-100 (1995).