Epidural Cortical Stimulation of the Left Dorsolateral Prefrontal Cortex for Refractory Major Depressive Disorder

Kopell, Brian H.; Halverson, Jerry; Butson, Christopher R.; Dickinson, Mercedes; Bobholz, Julie A.; Harsch, Harold H.; Rainey, Charles; Kondziolka, Douglas; Howland, Robert H; Eskandar, Emad N.; Evans, Karleyton C.; Dougherty, Darin D.

doi:10.1227/neu.0b013e318229cfcd

Cited by 63 publications

(40 citation statements)

References 56 publications

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“…Invasive cortical stimulation involves the surgical implantation of an electrode on the surface of the brain. The current results are likely to be pertinent to this technique, because the sites of cortical implantation tend to be the same targets used for noninvasive stimulation, including M1 in Parkinson's disease (129,130), M1 in essential tremor (54), premotor cortex in dystonia (131), left DLPFC in depression (132), cerebellum in epilepsy (133), and M1 in pain (61). Other noninvasive brain-stimulation modalities include electroconvulsive therapy and vagal nerve stimulation, which show therapeutic effi- (table).…”

Section: Brain Diseases Treated With Both Invasive and Noninvasive Stmentioning

confidence: 99%

Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases

Fox

Buckner

Liu

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

526

435

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Significance Brain stimulation is a powerful treatment for an increasing number of psychiatric and neurological diseases, but it is unclear why certain stimulation sites work or where in the brain is the best place to stimulate to treat a given patient or disease. We found that although different types of brain stimulation are applied in different locations, targets used to treat the same disease most often are nodes in the same brain network. These results suggest that brain networks might be used to understand why brain stimulation works and to improve therapy by identifying the best places to stimulate the brain.

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Section: Brain Diseases Treated With Both Invasive and Noninvasive Stmentioning

confidence: 99%

Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases

Fox

Buckner

Liu

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

526

435

View full text Add to dashboard Cite

show abstract

“…Though these surgical treatments have been reported to be successful in select patients, early reported studies of these procedures lack modern methodological approaches [9]. In addition to these ablative surgical procedures, neuromodulation procedures, such as vagus nerve stimulation [10], epidural cortical stimulation [11], and deep brain stimulation (DBS), have recently been employed. The theoretical advantages of these electrical stimulation therapies over lesion therapy are the reversibility and adaptability of therapy.…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation for Treatment-resistant Depression: Systematic Review of Clinical Outcomes

et al. 2014

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Major depressive disorder (MDD) is a widespread, severe, debilitating disorder that markedly diminishes quality of life. Medication is commonly effective, but 20-30 % of patients are refractory to medical therapy. The surgical treatment of psychiatric disorders has a negative stigma associated with it owing to historical abuses. Various ablative surgeries for MDD have been attempted with marginal success, but these studies lacked standardized outcome measures. The recent development of neuromodulation therapy, especially deep brain stimulation (DBS), has enabled controlled studies with sham stimulation and presents a potential therapeutic option that is both reversible and adjustable. We performed a systematic review of the literature pertaining to DBS for treatment-resistant depression to evaluate the safety and efficacy of this procedure. We included only studies using validated outcome measures. Our review identified 22 clinical research papers with 5 unique DBS approaches using different targets, including nucleus accumbens, ventral striatum/ventral capsule, subgenual cingulate cortex, lateral habenula, inferior thalamic nucleus, and medial forebrain bundle. Among the 22 published studies, only 3 were controlled trials, and 2, as yet unpublished, multicenter, randomized, controlled trials evaluating the efficacy of subgenual cingulate cortex and ventral striatum/ventral capsule DBS were recently discontinued owing to inefficacy based on futility analyses. Overall, the published response rate to DBS therapy, defined as the percentage of patients with>50 % improvement on the Hamilton Depression Rating Scale, is reported to be 40-70 %, and outcomes were comparable across studies. We conclude that DBS for MDD shows promise, but remains experimental and further accumulation of data is warranted.

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“…In the USA, depression is the primary diagnosis in 72-92 % of the 100,000 patients treated annually [67,68]. Yet high rates of relapse and amnesia, combined with stigma of the procedure, have prompted a continuing search for alternative therapies [69].…”

Section: Depressionmentioning

confidence: 99%

“…Epidural stimulation, born out of the aforementioned research, can potentially improve on TMS treatment with continuous stimulation at increased intensity and a better defined target [69]. Cortical stimulation also eradicates the risk inherent to parenchyma penetration with DBS.…”

Section: Depressionmentioning

confidence: 99%

Use of Cortical Stimulation in Neuropathic Pain, Tinnitus, Depression, and Movement Disorders

Panov

Kopell

2014

Neurotherapeutics

Self Cite

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Medical treatment must strike a balance between benefit and risk. As the field of neuromodulation develops, decreased invasiveness, in combination with maintenance of efficacy, has become a goal. We provide a review of the history of cortical stimulation from its origins to the current state. The first part discusses neuropathic pain and the nonpharmacological treatment options used. The second part covers transitions to tinnitus, believed by many to be another deafferentation disorder, its classification, and treatment. The third part focuses on major depression. The fourth section concludes with the discussion of the use of cortical stimulation in movement disorders. Each part discusses the development of the field, describes the current care protocols, and suggests future avenues for research needed to advance neuromodulation.

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Epidural Cortical Stimulation of the Left Dorsolateral Prefrontal Cortex for Refractory Major Depressive Disorder

Abstract: Epidural cortical stimulation of the left dorsolateral prefrontal cortex appears to be a safe and potentially efficacious neuromodulation approach for treatment-refractory major depressive disorder.

Cited by 63 publications

References 56 publications

Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases

Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases

Deep Brain Stimulation for Treatment-resistant Depression: Systematic Review of Clinical Outcomes

Use of Cortical Stimulation in Neuropathic Pain, Tinnitus, Depression, and Movement Disorders

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