New Kind of Brain Stimulation for Treatment Resistant Depression

In a recent online publication about another form of brain stimulation in treatment resistant depression showed promising results. The electrodes are placed on the brain instead of in the brain as with Deep Brain Stimulation (DBS):

A new neurosurgical procedure may prove helpful for patients with treatment-resistant depression. Bilateral epidural prefrontal cortical stimulation (EpCS) was found generally safe and provided significant improvement of depressive symptoms in a small group of patients

The location for Brain Stimulation in EpCS targets electrical stimulation to the anterior frontal poles and the lateral prefrontal cortex. Two different places on both hemispheres, resulting in four separate paddle leads which are connected to two small generators surgically implanted in the upper chest area of the patient. The leads are placed through a burr hole in the skull but above the dura mater and thus remain separated from the underlying cortical region by the arachnoid space. ECS is more direct than transcranial magnetic stimulation (TMS) and or vagus nerve stimulation (VNS) and potentially safer than deep brain stimulation (DBS), which involves passing the electrodes through brain tissue.

Of five patients three reached remission. Overall after seven months, the average improvement was 54.9 percent based on the Hamilton Rating Scare for Depression.

Advantages according to the team:

“Cortical stimulation has several advantages provided that it shows efficacy in treating depression. It is reversible, non-destructive and potentially safer than other forms of invasive brain stimulation since the stimulating paddles don’t come in direct contact with the brain.”

Deep Brain Stimulation is a neuro-surgical procedure used in mostly neurological and psychiatric disorders. In this procedure electrodes are placed in the brain, not on the brain. A great step forward, patients don’t have to be awake during the procedure. This post has a video showing a clear description of the old and new procedure for deep brain stimulation (DBS).

Deep Brain Stimulation (DBS) is mostly used for Parkinson’s Disease. DBS for Obsessive Compulsive Disorder and Depression is just starting to be used. It is unclear how DBS works for Parkinson’s Disease.

It is used for treatment resistant depression. When other treatments fail, deep-brain stimulation (DBS) may offer hope to patients suffering from chronic and severe depression. In recent published research about deep brain stimulation for treatment resistant depression, six months after surgery, 60% of patients were responders and 35% met criteria for remission, benefits that were largely maintained at 12 months.

The most appropriate target, optimal stimulation parameters, and long-term effects and efficacy remain uncertain. The targets for deep brain stimulation in treatment resistant depression has 6 options available.

Nahas, Z., Anderson, B., Borckardt, J., Arana, A., George, M., Reeves, S., & Takacs, I. (2009). Bilateral Epidural Prefrontal Cortical Stimulation for Treatment-Resistant Depression Biological Psychiatry DOI: 10.1016/j.biopsych.2009.08.021