Deep Brain Stimulation for Treatment-Resistant Depression: Towards a More Personalized Treatment Approach

Roet, Milaine; Boonstra, Jackson; Şahin, Erdi; Mulders, Anne E.P.; Leentjens, Albert F.G.; Jahanshahi, Ali

doi:10.3390/jcm9092729

Cited by 37 publications

(24 citation statements)

References 96 publications

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“…The inconsistent response rate in DBS studies in OCD and Depression cohorts always raises discussion about patient selection criteria and optimum deep brain targets and parameters for stimulation ( Roet et al, 2020 ; Figee and Mayberg, 2021 ). Research in AN is hampered by a scarcity of DBS studies and the complexity of clinical presentation, including numerous comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation of the Nucleus Accumbens in Severe Enduring Anorexia Nervosa: A Pilot Study

Scaife

Eraifej

Green

et al. 2022

Front. Behav. Neurosci.

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IntroductionAnorexia nervosa (AN) is one of the most debilitating psychiatric disorders, becoming severe and enduring in a third of cases; with few effective treatments. Deep brain stimulation is a reversible, adjustable neurosurgical procedure that has been gaining ground in psychiatry as a treatment for depression and obsessive–compulsive disorder, yet few studies have investigated AN. Abnormal eating behavior and the compulsive pursuit of thinness in AN is, in part, a consequence of dysfunction in reward circuitry and the nucleus accumbens (NAcc) is central to reward processing.MethodsPhase 1 prospective open-label pilot study of seven individuals with severe enduring AN. Electrodes were implanted bilaterally into the NAcc with stimulation at the anterior limb of the internal capsule using rechargeable implantable pulse generators. The protocol of 15 months included 12 months of deep brain stimulation incorporating two consecutive, randomized blind on-off fortnights 9 months after stimulation onset. The primary objectives were to investigate safety and feasibility, together with changes in eating disorder psychopathology.ResultsFeasibility and safety was demonstrated with no serious adverse events due to deep brain stimulation. Three patients responded to treatment [defined as > 35% reduction in Eating Disorders Examination (EDE) score at 12 months] and four patients were non-responders. Responders had a statistically significant mean reduction in EDE scores (50.3% reduction; 95% CI 2.6–98.2%), Clinical Impairment Assessment (45.6% reduction; 95% CI 7.4–83.7%). Responders also had a statistically significant mean reduction in Hamilton Depression Scale, Hamilton Anxiety Scale and Snaith-Hamilton pleasure scale. There were no statistically significant changes in Body Mass Index, Yale-Brown-Cornell Eating Disorder Scale, Yale-Brown Obsessive–Compulsive Scale and World Health Organization Quality of Life Psychological subscale.ConclusionThis study provides some preliminary indication that deep brain stimulation to the NAcc. Might potentially improve some key features of enduring AN. In this small study, the three responders had comorbid obsessive-compulsive disorder which predated AN diagnosis. Future studies should aim to further elucidate predictors of outcome.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [Project ID 128658].

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Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation of the Nucleus Accumbens in Severe Enduring Anorexia Nervosa: A Pilot Study

Scaife

Eraifej

Green

et al. 2022

Front. Behav. Neurosci.

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“…An automated data driven approach to determining optimal stimulation settings would reduce the burden on clinicians and likely improve patient outcomes. This is true for epilepsy patients, and for patients receiving or exploring electrical stimulation for a range of neurological disorders and disabilities, including Parkinson’s 61,76 , Essential Tremor 63,85 , chronic pain 86,87 , Obsessive Compulsive Disorder 88,89 , and Depression 90,91 . Our work highlights the potential benefits of a Bayesian optimization approach.…”

Section: Discussionmentioning

confidence: 99%

Optimization of closed-loop electrical stimulation enables robust cerebellar-directed seizure control

Stieve

Richner

Krook-Magnuson

et al. 2021

Preprint

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Additional treatment options for temporal lobe epilepsy are needed, and potential interventions targeting the cerebellum are of interest. Previous animal work has shown strong inhibition of hippocampal seizures through on-demand optogenetic manipulation of the cerebellum. However, decades of work examining electrical stimulation - a more immediately translatable approach - targeting the cerebellum has produced very mixed results. We were therefore interested in exploring the impact that stimulation parameters may have on seizure outcomes. Using a mouse model of temporal lobe epilepsy, we conducted on-demand electrical stimulation of the cerebellar cortex, and varied stimulation charge, frequency, and pulse width, resulting in over a thousand different potential combinations of settings. To explore this parameter space in an efficient, data-driven, manner, we utilized Bayesian optimization with Gaussian process regression, implemented in Matlab with an Expected Improvement Plus acquisition function. We examined two different fitting conditions and two different electrode orientations. Following the optimization process, we conducted additional on-demand experiments to test the effectiveness of selected settings. Across all animals, we found that Bayesian optimization allowed identification of effective intervention settings. Additionally, generally similar optimal settings were identified across animals, suggesting that personalized optimization may not always be necessary. While optimal settings were consistently effective, stimulation with settings predicted from the Gaussian process regression to be ineffective failed to provide seizure control. Taken together, our results provide a blueprint for exploration of a large parameter space for seizure control, and illustrate that robust inhibition of seizures can be achieved with electrical stimulation of the cerebellum, but only if the correct stimulation parameters are used.

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“…For these group of patients, especially who still have had multiple episodes of major depression for long years with Hamilton Depression Rating Scale between 25-40 despite they were applied all other treatment choices including maximal pharmacotherapy and cognitive-behavioral therapy, DBS seems to be an effective choice [7] .There has been two beneficial guides to select the targets for DBS in Treatment Resistant Depression. One is clinical outcomes of psychiatric improvement following DBS in Obsessive-Compulsive Disorder, and the other one is neuroimaging studies [16,17]. The neuroimaging studies and both open-label and randomized controlled trials to date demonstrate that Subcallosaal Cingulate Cortex, Nucleus accumbens, Ventral Capsule and Ventral Stiratum and Medial Forebrain Bundle seemed to be main targets for DBS in treatment resistant depression.…”

Section: Treatment Resistant Depression (Trd)mentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: A review

Boztaş¹,

Yenice²

2021

2791-6332

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Deep Brain Stimulation (DBS) is a neurosurgical procedure via the placement of neurostimulator, which is a medical device also known as brain pacemaker. The electrical impulses, which are sent to s pecific targets of brain through implanted electrodes, used in the treatment of some neurological and psychiatric disorders. While the mechanisms of action of DBS on the physiology on brain cells and neurotransmitters are controversial, it is well known that high-frequency electrical impulses into specific brain areas can diminish certain symptoms of some neurological and psychiatric disorders. DBS is already approved as a treatment for several neurological disorders by the Food and Drug Administration (FDA). It is approved as a treatment for essential tremor in 1997 and Parkinson's disease since 2002, for dystonia in 2003 and for epilepsy in 2018. There are also variety uses of DBS in psychiatric disorders with resistance to treatment, such as obsessive compulsive disorder, Tourette's syndrome, major depressive disorder, post-traumatic stress disorder, appetite disorders, alcohol and substance use disorders and also schizophrenia. This article outlines using of deep brain stimulation as a treatment method for psychiatric disorders which are resistant to medical treatments and psychotherapies, as well as the appropriate anatomical targets and the possible mechanism of actions.

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Deep Brain Stimulation for Treatment-Resistant Depression: Towards a More Personalized Treatment Approach

Cited by 37 publications

References 96 publications

Deep Brain Stimulation of the Nucleus Accumbens in Severe Enduring Anorexia Nervosa: A Pilot Study

Deep Brain Stimulation of the Nucleus Accumbens in Severe Enduring Anorexia Nervosa: A Pilot Study

Optimization of closed-loop electrical stimulation enables robust cerebellar-directed seizure control

Deep brain stimulation for psychiatric disorders: A review

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