The operation is Wednesday. Patient 005 is having a deep brain stimulation device implanted on Wednesday, give him some support, here: DBS Trial
Search Results for: "deep brain stimulation"
In Deep Brain Stimulation for treatment resistant depression with stimulation of Broadman area 25 (Cg 25) no consistent declines in memory for either verbal or visual material were noted after onset or maintenance of DBS over baseline. This makes DBS a procedure with out apparent cognitive side effects in treatment resistant depression. In a recent publication with DBS in the Subthalamic Nucleus for treatment resistant Obsessive Compulsive Disorder (OCD) no cognitive decline was found. The ratings of neuropsychological measures were not modified by stimulation.
In 17 patients participating in this 10-month, crossover, double-blind, multicenter study assessing the efficacy and safety of stimulation of the subthalamic nucleus one patient had a parenchymal brain hemorrhage (bleeding) resulting in a permanent finger palsy. Two patients had an infection leading to removal of the pulse generator. Seven transient motor and psychiatric symptoms induced by active stimulation occurred in the first month of stimulation and resolved spontaneously or rapidly after adjustment of the setting. Ten other patients also had serious but transient side-effects.Three patients became hypomanic, three suffered from anxiety, two of depressive symptomps the others suffered from transient neurological side-effects such as dyskinesia, trouble walking, dysarthria, dysphagia and facial asymmetry.
Deep Brain Stimulation of the subthalamic nucleus significantly reduced the symptoms of severe forms of OCD.
In conclusion, findings from this 3-month crossover study suggest that stimulation of the subthalamic nucleus may lessen the severity of obsessive–compulsive symptoms and improve global functioning in patients with refractory, severe OCD. Serious adverse events occurred in 11 of the 17 patients in whom stimulators were implanted. The occurrence of severe adverse events, the small number of patients, and the short duration of the study highlight the risks of stimulation of the subthalamic nucleus and the need for larger studies with longer follow-up. In addition to assessment in a larger number of patients, a comparison with other stimulation targets and surgical procedures would be desirable, as would an evaluation of the long-term benefits of stimulation of the subthalamic nucleus in patients with OCD, notably with respect to their quality of life and their ability to function in social and work environments.
On Medpage today a summary of a variety of alternative approaches that apply electrical currents to the brain are in the research pipeline, and one is FDA approved. A summary of VNS, rTMS, magnetic seizure therapy, deep brain stimulation , TDCS and Implantable cortical stimulation. Never heard of that last one, a new form of neurostimulation?
Implantable cortical stimulation
Another early-stage investigational technology takes vagus nerve stimulation a step farther. Instead of delivering electrical pulses to a nerve, it sends them to the surface of the brain. Seattle-based Northstar Neurosciences is testing a system that, like vagus nerve stimulation, inserts a pulse generator in the patient’s chest. An electrical lead is passed into the skull through a surgically drilled hole, terminating on the dural membrane over the cortex.
A nice overview.
On Psych Central: Brain Pacemaker Shows Potential
A short description of the history of deep brain stimulation and two case reports with exceptional indications for deep brain stimulation: one patient was treated for body dysmorphic disorder and the other was treated for debilitating headaches.
Body dysmorphic disorder is excessive preoccupation with minor or imagined flaws in appearance. Dr. Anderson’s patient was a 20-year-old man who obsessed on perceived flaws with his nose and other facial features. He had attempted suicide once, and described his life as a “living hell.” Eight months after DBS surgery, the patient reported mild depression and obsessive compulsive disorder, but no symptoms of body dysmorphic disorder.
The second patient was a 43-year-old woman who suffered paroxysmal hemicrania headaches around the orbit of her right eye. She would typically get 10 to 20 attacks per day, each lasting 2 to 20 minutes. The headaches did not respond to either medications or a nerve block. But as soon as the DBS device was turned on, the woman reported the pain went away.
5 Features of inadequate treatment for Depression are:
- The most common source of lack of response in depression is the administration of inadequate dosage. With some antidepressants, the tricyclic antidepressants (TCAs), there is evidence for a relationship between plasma levels and therapeutic outcome
- Treatment duration with antidepressants. There is some evidence that elderly patients may require longer exposure to medication. At least adequate dosage during 4 weeks is the absolute minimum.
- Adherence with treatment. Improvement is unlikely if patients do not adhere to treatment. Side-effects are a common cause.
- It is important to evaluate treatment outcome. The greater the level of depressive symptomatology following antidepressant treatment the higher the probability of relapse. The goal in treating the acute episode is to achieve remission
- Wrong diagnosis. If the antidepressant doesn’t work this option should be considered. Several somatic illnesses and medication can present with depressive symptoms.
Nevertheless it is estimated that 20-40% of patients with a major depressive episode do not show substantial clinical improvement to their first antidepressant treatment.
Staging methods to assess levels of treatment resistance in depression are being developed:
- The Antidepressant Treatment History form. A clinician rated instrument. This form is empirically validated via prospective treatment outcome reports. This form is mostly used with electroconvulsive therapy (ECT) outcome. There is debate about the influence of treatment resistance and efficacy of ECT. Some studies show a negative influence on ECT outcome of medication resistance other studies can’t find such an influence.
- Harvard Antidepressant Treatment History. Clinician rated instrument.
- Massachusetts General Hospital Treatment Response Questionnaire. Patient rated instrument. Advantage of this instrument is the absence of clinicians’ biases, particularly when treatment resistance is required for inclusion in a study.
The advantage of MST is the ability to produce focal stimulation. Stimulation of areas likely to be most involved in the cognitive side-effects of ECT can be more easily avoided. From studies with ECT it is hypothesized that initiation of the seizure in the prefrontal cortex explains the efficacy of bilateral electrode placement and supratreshold unilateral electrode placement. Magnetic stimulation holds the promise of more precise control over current paths and current density in neural tissue. The scalp and scull are transparent to magnetic fields. With an electric stimulus as in ECT, the current is highly variable and the distribution widespread and their is little control over the intra cerebral current density.
A drawback of MST is similar to that of ECT, patients must receive general anaesthesia with muscle paralysis during the seizure induction.
Dr Shock was reading up on his literature. While reading a review about “Targeting abnormal neural circuits in mood and anxiety disorders…” in Nature Neuroscience he read about this new technique. Searching GoPubMed he discovered 20 articles of which 6 were relevant.
Publications about Magnetic Seizure Therapy
Of these publications there were two case reports and one publication about MST in rhesus monkeys. There was one clinical trial. It is free to read, as in free beer. Ten inpatients with depression participated in a randomized, within-subject, double-blind trial. They were treated with two ECT sessions and two MST sessions, raters were unaware of the treatment schedule. MST had shorter seizure duration, lower ictal EEG amplitude and less postictal suppression. MTS sessions gave fewer subjective side-effects. MST was alos superior to ECT on measures of attention an retrograde amnesia. Efficacy was not an outcome measure.
Conclusion about Magnetic Seizure Therapy
MST is feasible in depressed patients and appears to have a superior acute side effect profile. Antidepressant efficacy needs to be esthablished.
So it will take a while before Dr Shock might have to change his name to…Dr Magnet?
Deep Brain Stimulation
Helen Mayberg found the switch that lifts depression in area 25, a spot deep in the cortex. This area is the key conduit of neural traffic between the thinking frontal cortex or forebrain and the central limbic region that plays a role in emotions and which appeared earlier in our evolutionary development. This area is overactive during depression or sadness. “Like a gate left open” she says. In contrast to this area both the frontal cortex and limbic region were less active as discovered with positron-emission tomography (PET)in depressed patients with Parkinson’s disease compared to not depressed patients with this neurological disorder. Area 25 was also hyperactive in depressed patients without neurological disease. Patients that recovered form depression showed a rise in frontal activity and a calming in area 25. Area 25 also dampened when depressed patients responded to cognitive therapy.
The whole story from the discovery of the relation between area 25 and depression to Deep Brain Stimulation (DBS) is told in a very readable chapter of the book: Best of the Brain from Scientific American, Mind, Matter, and Tomorrow’s brain. Received this excellent book just a few days ago and read two chapters already in bed before going to sleep. I even finished the chapters before falling a sleep, that’s a remarkable quality of the writers, usually it takes 10 minutes before I fall a sleep. I am very enthusiastic about this book so I had to tell you this story before reading the whole book and writing a complete review. Anyone with interest in the brain and results of recent research should read this book. It is easy to read. For the table of content please see The Dana Foundation. The Dana Foundation is a private philanthropy with principal interests in brain science, immunology, and arts education.
Now back to the discovery of area 25 and DBS. With a group of researcher at the University of Toronto they sought a way to return the area back to normal activity. The group decided to try inserting electrodes in area 25 in a dozen severely depressed patients that had not responded to several antidepressants and ECT. A pair of electrodes and slender leads were slid in to area 25 after drilling a pair of nickel-size holes in the skull. A pacemaker was attached to the leads and placed under the collarbone. After turning the pacemaker on two thirds of the patients were completely recovered, never felt better.
Not only was there a new cure found for severely depressed patients not responding to the usual treatment but also our way of thinking about the brain has changed. The brain works as a system of coordinated functions that arise from different regions, rather than as a single unit.
The chapter holds even more background information and interesting results with cognitive behavioural therapy and brain imaging, go get it.
A commentary in the JAMA by Prof Max Fink. In this commentayr he sumarizes the most important recent topics in ECT.
1. Remission for depressive illness with ECT: 55%-86%, these results compare favorably to the response rates in the STAR*D trial.
2. Relapse prevention after ECT, nortriptyline with lithium is first choice, continuation ECT for patients who relapse despite this treatment and for those who may not tolerate medication.
3. ECT is a primary treatment for psychotic depression.
4. ECT reduces the acute risk for suicide.
5. Medication resistance does not bare relation to treatment efficacy with ECT.
6. He still favours bilateral electrode placement.
7. Important side effects are anterograde-, retrograde amnesia.
8. Vagus Nerve Stimulation and Deep Brain Stimulation are not comparable in efficacy to ECT.
This is in short his few about the recent achievements in ECT treatment and it’s research. His preference for bilateral ECT is a topic for debate. Unilateral electrode placement is technically more complex but comparable in efficacy when done the right way. That is with supratreshold stimulus dosage after stimulus titration during the first session. Research with side effects should be done for the long term and focussed on individual differences
Cyberonics Inc. on Monday said the United States Food and Drug Administration has approved its Demipulse and Demipulse Duo generators for commercial release. The products are used for vagus nerve stimulation, which is used in the treatment of epilepsy and certain types of depression.
In August 2006 Cyberonics saw the FDA reject the company’s application to use its implantable generator to treat depression in patients who do not respond to medications. Mainly due to disappointing results of clinical trials. In the only randomized controlled trial VNS failed to perform any better when turned on than in otherwise similar implanted patients whose device was not turned on. For summary of safety and effectiveness data see this FDA rapport.
The pacemaker-like device, which is surgically implanted into a patient, has been available in the U.S. since 1997 as a treatment for epilepsy.
VNS uses a stimulator that sends electric impulses to the left vagus nerve in the neck via a lead implanted under the skin. The left vagus nerve is stimulated rather than the right because the right plays a role in cardiac function such that stimulating it could have negative cardiac effects. The exact method of therapeutic action is unknown, but VNS has been shown to affect blood flow to different parts of the brain, and affect neurotransmitters including Serotonin and Norepinephrine which are implicated in depression. Some patients experience an alteration of voice quality and loudness during the time that the pulse is being delivered to the vagus nerve. Other common side effects include hoarseness, throat pain, cough, shortness of breath.
For further eading on VNS please see Wikipedia.
For more explanations about the differences between VNS, Magnetic Brain Stimulation and Deep Brain Stimulation, please see this website from Biotele.
For more information about VNS see this page from the Mayo Clinic. And this one for Deep Brain Stimulation.
My opinion is that efficacy is not proven for these treatments for depression although there are patients that can benefit. Before you try one of these methods be sure they have been treated with all regular options including ECT or electroshock.
Technology Review: Brain Electrodes Help Treat Depression
Electrically stimulating specific parts of the brain using an implanted electrode can help severely depressed patients, according to two studies published this month. The findings are the latest evidence suggesting that “deep brain stimulation,” a surgical therapy already widely used to treat Parkinson’s disease, could be an alternative treatment for people with severe depression.
There are also many ways to treat depression, unconventional for some, like the use of CBD oil, as many research says that it has a positive reaction and interaction with serotonin receptors in the brain, according to medcardnow.com you can get your med car to have a discount on any cannabis item, it impacts the emotional state and the feeling of being happy. This is used as therapy and not only for this disease but also for anxiety, cancer patients, glaucoma, and parkinson which is still on many studies but all had come out positive. can CBD oil help Parkinson’s? many ask themselves and to their doctors this question and research says it does, depending on the patient symptoms and how it affects him it can actually help the body in a huge percentage.
CBD Oil Basics
CBD is short for cannabidiol, a chemical compound found within the cannabis plant that binds to cannabinoid receptors located in the body’s endocannabinoid system.
CBD is different than other cannabinoids found in the marijuana plant that are known for producing the high commonly associated with medical marijuana use. This includes tetrahydrocannabinol (THC) and a similar cannabinoid, tetrahydrocannabivarin (THCV). Both THC and THCV can produce this high effect, whereas CBD does not.
Additionally, our bodies do produce some cannabinoids on its own. These are called endogenous cannabinoids because they are so similar to cannabis plant compounds. CBD from Global Cannabinoids works by mimicking and augmenting these natural cannabinoids, providing a more therapeutic effect.
Admittedly, information in this field is still emerging, primarily because the endocannabinoid system is a relatively new finding due to the first endocannabinoid not being discovered until 1992.
After the second one was identified three years later, researchers began to realize that the human body has an entire endocannabinoid system that offers positive effects related to bone density and diabetes prevention.
Since that time, research has also connected CBD with providing benefits for Parkinson’s disease.
CBD Oil Legalities
One of the major concerns patients have with the use of CBD oil is whether or not it is legal. Psychology Today stresses that, while many people think that the passing of the 2018 Farm Bill legalized CBD federally, this isn’t exactly the case.
Instead, the Farm Bill only legalized hemp, which is the fibrous stalk of the marijuana plant. Technically, all other parts of the plant are still illegal under the Controlled Substances Act.
What confuses the issue even more is that each state has set its own statutes regarding hemp, medical marijuana, and CBD. For instance, in New York, patients can smoke cannabis, but they aren’t banned from accessing it as a dried flower. However, if you live in Colorado, not only can individuals use medical cannabis, but children can even legally possess it on school campuses if they have status as a medical cannabis patient.
Because of these variations, it is always recommended that Parkinson’s patients check the legality of cannabis use or CBD oil in their individual states before utilizing this option for treatment purposes.
Still, experts urge caution in interpreting the results. For one thing, says Karl Deisseroth, a psychiatrist at Stanford who studies experimental treatments for depression, “no placebo-controlled trials have been done” to confirm how well the therapy works on a larger population.Doctors involved in the studies caution that larger clinical trials are needed to determine how effective and long-lasting the therapy is.