pico deep brain stimulation for treatment resistant depression. clinical reality ?
Post on 21-Dec-2015
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PICO
Deep brain stimulation for
treatment resistant depression.
Clinical reality ?
Deep brain stimulation in the treatment of depression.
Acta Psychiatr Scand, 2011
Blomstedt P et al.
Subcal.cing. gyrus (no 20)85% had ECTHDRS - 52% / 1
year35% remission
Capsula interna (no 15)100% had ECTHDRS -44% / 1 year40% remission
Nucleus accumbens (no 10)100% had ECTHDRS - 36% / 1
year30% remission
Subcallosal Cingulate Gyrus Deep Brain Stimulation for Treatment-
Resistant Depression
Biological Psychiatry, 2008
Lozano, et al
Increased activity in the subcallosal cingulate gyrus
Pharmacotherapy
Transcranial magnetic stimulation
Electroconvulsive therapy
Altered activity of the SCG
Deep brain stimulation
Direct modulation of the SCG
Inclusion
Severe
Chronic
Treatment resistant
Failure to respond to a minimum of four different treatments
Antidepressant pharmacotherapy of sufficient dose and duration
Evidence-based psychotherapy
Electroconvulsive therapy
Exclusion
comorbid Axis I psychiatric conditions,
Axis II cluster B diagnosis
suicidal behaviour within the past year
concurrent neurological or medical conditions that could interfere with
the treatment.
Subjects (n = 20)
Male/female 9/11
Age at Enrollment (years) 47.4 ± 10.4
Age of Onset of MDD (years) 27.1 ± 8.3
Length of Current Episode (years) 6.9 ± 5.6
Number of Lifetime MDE (n) 3.9 ± 3.1
Received ECT (n) 17/20
Baseline HRSD-17 24.4 ± 3.5
3 patients received no ECT before DSTAll patients received medication during DST
Adverse EffectNumber of
Patients
Wound Infection and Hardware removal 3
Reinsertion of DBS Hardware 1
Wound Infection Managed with Antibiotics Alone
1
Perioperative Seizure 1
Worsening Mood/Irritability 2
Perioperative Headache 4
Pain at Pulse Generator Site 1
No Adverse Effects 7
Deep Brain Stimulation for Treatment-Resistant Depression: Follow-Up
After 3 to 6 Years
Kennedy, et al.
Am J Psychiatry, 2011
1 unrelated death2 suicides2 lost to follow up3 devices removed
Argument in favour
Otherwise intractable depression
Remission rates around 30 %
Possible long term benefits
Arguments against
No clear target-area
Invasive procedure
Battery life
Open label assessment
Small N
Concurrent medication use
In conclusion
Experimental therapy
Clinical studies
Multidisciplinary teams