- Email: [email protected]
Deep brain stimulation (DBS) for treatment resistant depression (TRD): 5 year follow up
466
Abstracts / Brain Stimulation 10 (2017) 346e540
neurophysiological changes are related to the severity of the disease. These findings lead to a possible alteration in neurotransmission cortical systems GABA and NMDA mediated by the degree of hypoxemia. Keywords: Transcranial magnetic stimulation, obstructive sleep apnea syndrome, neuropsychology, corticospinal excitability [0501] STIMULATION OF THE SOMATOSENSORY CORTEX USING HD-TDCS MODULATES OTHERS' PAIN PERCEPTION; COMBINED EVIDENCE FROM BEHAVIOUR, EEG, FMRI DATA S. Gallo*1, T. Maskaljunas 1, B. Lammes 1, C. Henriques 1, J. Suttrup 1, C. Keysers 1, 2, V. Gazzola 1, 2. 1 Netherlands Institute for Neuroscience, The Netherlands; 2 University of Amsterdam, The Netherlands The vicarious brain regions active both when we are in pain and when witnessing another persons’ suffering are considered the neural basis for empathy for pain. To investigate the causal role of the somatosensory cortex (SI) in perception of others’ pain we used a bi-hemispheric 1x1 High-Definition Transcranial Direct Current Stimulation (HD-tDCS), which we expect to have subject dependent effects. To have a direct measure of stimulation on cortical excitability, we recorded somatosensory evoked potential (SEP) before and after anodal or sham HD-tDCS (18 min). After HD-tDCS, participants moved inside an fMRI scanner. First, we recorded an image of the participant wearing the electrodes-cap. Then, participants watched videos of painful stimulations on a right hand in which the face reaction of the person (Face-Videos) or only the hand (Hand-Videos) was visible or in which the saturation changed over time (Color-Videos). Participants rated (1 to 8) painfulness or saturation. As expected no group effect was identified. Explorative multiple regression models allowed to unveil that the position of the left cathode predicted the amplitude of HD-tDCS effect on SI brain activity measured both as difference in the peak-to-peak SEP-component P24-N20 (p<0.05) and as BOLD difference while watching the Face-Videos (p<0.005) but not Hand and Color ones. Moreover the index of the same SEP-component predicted the change in average rating of the Face-Videos (p<0.05). We used a novel HD-tDCS montage to investigate the role of the somatosensory cortex in others’ pain perception. At the individual level, results revealed that difference in electrodes location leaded to difference in tDCS effect on SI cortical excitability (SEP) and on BOLD signal related to watching the Face-Videos. SI cortical excitability also related to difference in rating the pain when the face of the person was visible, suggesting a key role of this area in perception of others’pain. Keywords: empathy for pain, HD-tDCS, individual difference [0503] DEEP BRAIN STIMULATION (DBS) FOR DEPRESSION (TRD): 5 YEAR FOLLOW UP
TREATMENT
RESISTANT
M.A. Cristancho*1, M.T. Bhati 2, J.P. O'Reardon 3, G.H. Baltuch 1. 1 University of Pennsylvania, USA; 2 Stanford University, USA; 3 VA Medical Center, USA Introduction: About 30% of patients with depression fail to respond to conventional treatments, a clinical course called TRD. DBS offers a treatment option for severe TRD. We report the 5year clinical outcomes of a cohort of 8 patients who received DBS in the ventral capsule/ventral striatum(VC/VS). Methods: A consecutive series of 8 patients with severe TRD were implanted at the University of Pennsylvania. DBS in the VC/VS bilaterally was added to medication treatment. Baseline severity and treatment response was assessed using the MADRS and categorical outcomes (remission/response) and continuous outcomes (MADRS reduction) are reported. DBS was flexibly dosed based on treatment response. Results: The sample had severe TRD (75% lifetime history of ECT) and a highly recurrent course. For the intent-to-treat sample (n¼8) the response rate (50% improvement) at 5years was 50% and the remission rate (MARDS 10) was 38%. Mean MADRS score at baseline was 36.5 and it reduced to 18.9 at 5years indicating improvement from severe to mild to moderate depression.
Mean MADRS scores at 6months and 12months were 28 and 22 respectively. Among responders (n¼5 ), 80% were receiving bipolar stimulation. Electrodes 0 and 1 were the most frequently used. Voltage ranged from 4-10V. The most commonly used PW was 210msec. Stimulation frequency was set at 130Hz. Three patients discontinued stimulation due to lack of improvement , of those 2 were explanted and 1 committed suicide. There was 1 surgical infection and 4 transient affective switches, otherwise stimulation was well tolerated. All active patients required replacement of the original battery. Discussion: DBS offers meaningful long-term benefit as adjunctive therapy for severe TRD. Clinical benefit was more apparent beyond the 12month mark and sustaind over time. This suggests that DBS discontinuation before 2years may be premature. This data points out to the need for longer duration clinical trials. [0504] CLINICAL PREDICTORS OF ANTIDEPRESSANT RESPONSE OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION IN DEPRESSIVE DISORDER: A NATURALISTIC STUDY R. Rostami*1, 2, R. Kazemi 2. Neuroscience Center, Iran
1
Tehran University, Iran;
2
Atieh Clinical
Introduction: rTMS is a treatment for depression that widely use in clinics the worldwide. Ever studies have examined clinical predictors of response of rTMS used the data from clinical trials have questionnaires based on clinician‘s assessment. In a retrospective study to investigate clinical predictors used self-report Beck Depression Inventory (BDI-II) was completed in the clinic. Method: 250 patients with depression who received rTMS examined with respect to demographic characteristics and their scores on the Beck Depression Inventory (BDI-II). In order to identify the most relevant items of BDI as predictors of response to rTMS, we used feature ranking methods. Mutual information (MI), Kullback-Leibler divergence (KL) and receiver operating characteristics (ROC) were used as three methods to rank dimensions of our feature space. Results: Ranking techniques were performed on two groups of features, In the first group, according to MI criterion “affective cognitive BDI” became the most important element, while KL and ROC methods resulted in “concentration difficulty” to have the highest rank. “Agitation” was selected to be the second most important element by KL and ROC criteria, while “concentration difficulty” was reported as the second element by MI. Considering the second set of features (only 21 items of BDI), all methods reported “concentration difficulty” to be the element with the highest rank. “Agitation” was selected as the second most relevant BDI element by KL and ROC, whereas “suicidal thoughts and wishes” were reported to be the second element regarding MI criterion. Discussion: These findings showed important role of cognitive dysfunction as the predictor rTMS in depressed patients. Keywords: Clinical predictor, Depressive disorder [0505] MODELING, TARGETING AND OPTIMIZING TRANSCRANIAL CURRENT STIMULATION (TCS)
MULTICHANNEL
G. Ruffini*1, M.D. Fox 2, E. Santarnecchi 2, P.C. Miranda 3, D. Edwards 4, F. Wendling 5, A. Pascual-Leone 2. 1 Neuroelectrics Corporation, USA; 2 Harvard Medical School, USA; 3 Universidade de Lisboa, Portugal; 4 BurkeCornell Medical Research Institute, USA; 5 INSERM, LTSI, France The electric field associated to transcranial currents or time-varying magnetic fields provides the first mechanistic link between non-invasive brain stimulation techniques and their physiological effects. More specifically, to first order, effects are a function of the magnitude and direction of the component of the electric field perpendicular to the cortical surface, as mediated by the coherent alteration of the trans-membrane potential in pyramidal neuron populations. We describe the creation of realistic head models to estimate cortical electric fields generated by tCS, their limitations, and the opportunity of using them to model and optimize the effects of stimulation, e.g., in computational models. We emphasize first the
Abstracts / Brain Stimulation 10 (2017) 346e540
neurophysiological changes are related to the severity of the disease. These findings lead to a possible alteration in neurotransmission cortical systems GABA and NMDA mediated by the degree of hypoxemia. Keywords: Transcranial magnetic stimulation, obstructive sleep apnea syndrome, neuropsychology, corticospinal excitability [0501] STIMULATION OF THE SOMATOSENSORY CORTEX USING HD-TDCS MODULATES OTHERS' PAIN PERCEPTION; COMBINED EVIDENCE FROM BEHAVIOUR, EEG, FMRI DATA S. Gallo*1, T. Maskaljunas 1, B. Lammes 1, C. Henriques 1, J. Suttrup 1, C. Keysers 1, 2, V. Gazzola 1, 2. 1 Netherlands Institute for Neuroscience, The Netherlands; 2 University of Amsterdam, The Netherlands The vicarious brain regions active both when we are in pain and when witnessing another persons’ suffering are considered the neural basis for empathy for pain. To investigate the causal role of the somatosensory cortex (SI) in perception of others’ pain we used a bi-hemispheric 1x1 High-Definition Transcranial Direct Current Stimulation (HD-tDCS), which we expect to have subject dependent effects. To have a direct measure of stimulation on cortical excitability, we recorded somatosensory evoked potential (SEP) before and after anodal or sham HD-tDCS (18 min). After HD-tDCS, participants moved inside an fMRI scanner. First, we recorded an image of the participant wearing the electrodes-cap. Then, participants watched videos of painful stimulations on a right hand in which the face reaction of the person (Face-Videos) or only the hand (Hand-Videos) was visible or in which the saturation changed over time (Color-Videos). Participants rated (1 to 8) painfulness or saturation. As expected no group effect was identified. Explorative multiple regression models allowed to unveil that the position of the left cathode predicted the amplitude of HD-tDCS effect on SI brain activity measured both as difference in the peak-to-peak SEP-component P24-N20 (p<0.05) and as BOLD difference while watching the Face-Videos (p<0.005) but not Hand and Color ones. Moreover the index of the same SEP-component predicted the change in average rating of the Face-Videos (p<0.05). We used a novel HD-tDCS montage to investigate the role of the somatosensory cortex in others’ pain perception. At the individual level, results revealed that difference in electrodes location leaded to difference in tDCS effect on SI cortical excitability (SEP) and on BOLD signal related to watching the Face-Videos. SI cortical excitability also related to difference in rating the pain when the face of the person was visible, suggesting a key role of this area in perception of others’pain. Keywords: empathy for pain, HD-tDCS, individual difference [0503] DEEP BRAIN STIMULATION (DBS) FOR DEPRESSION (TRD): 5 YEAR FOLLOW UP
TREATMENT
RESISTANT
M.A. Cristancho*1, M.T. Bhati 2, J.P. O'Reardon 3, G.H. Baltuch 1. 1 University of Pennsylvania, USA; 2 Stanford University, USA; 3 VA Medical Center, USA Introduction: About 30% of patients with depression fail to respond to conventional treatments, a clinical course called TRD. DBS offers a treatment option for severe TRD. We report the 5year clinical outcomes of a cohort of 8 patients who received DBS in the ventral capsule/ventral striatum(VC/VS). Methods: A consecutive series of 8 patients with severe TRD were implanted at the University of Pennsylvania. DBS in the VC/VS bilaterally was added to medication treatment. Baseline severity and treatment response was assessed using the MADRS and categorical outcomes (remission/response) and continuous outcomes (MADRS reduction) are reported. DBS was flexibly dosed based on treatment response. Results: The sample had severe TRD (75% lifetime history of ECT) and a highly recurrent course. For the intent-to-treat sample (n¼8) the response rate (50% improvement) at 5years was 50% and the remission rate (MARDS 10) was 38%. Mean MADRS score at baseline was 36.5 and it reduced to 18.9 at 5years indicating improvement from severe to mild to moderate depression.
Mean MADRS scores at 6months and 12months were 28 and 22 respectively. Among responders (n¼5 ), 80% were receiving bipolar stimulation. Electrodes 0 and 1 were the most frequently used. Voltage ranged from 4-10V. The most commonly used PW was 210msec. Stimulation frequency was set at 130Hz. Three patients discontinued stimulation due to lack of improvement , of those 2 were explanted and 1 committed suicide. There was 1 surgical infection and 4 transient affective switches, otherwise stimulation was well tolerated. All active patients required replacement of the original battery. Discussion: DBS offers meaningful long-term benefit as adjunctive therapy for severe TRD. Clinical benefit was more apparent beyond the 12month mark and sustaind over time. This suggests that DBS discontinuation before 2years may be premature. This data points out to the need for longer duration clinical trials. [0504] CLINICAL PREDICTORS OF ANTIDEPRESSANT RESPONSE OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION IN DEPRESSIVE DISORDER: A NATURALISTIC STUDY R. Rostami*1, 2, R. Kazemi 2. Neuroscience Center, Iran
1
Tehran University, Iran;
2
Atieh Clinical
Introduction: rTMS is a treatment for depression that widely use in clinics the worldwide. Ever studies have examined clinical predictors of response of rTMS used the data from clinical trials have questionnaires based on clinician‘s assessment. In a retrospective study to investigate clinical predictors used self-report Beck Depression Inventory (BDI-II) was completed in the clinic. Method: 250 patients with depression who received rTMS examined with respect to demographic characteristics and their scores on the Beck Depression Inventory (BDI-II). In order to identify the most relevant items of BDI as predictors of response to rTMS, we used feature ranking methods. Mutual information (MI), Kullback-Leibler divergence (KL) and receiver operating characteristics (ROC) were used as three methods to rank dimensions of our feature space. Results: Ranking techniques were performed on two groups of features, In the first group, according to MI criterion “affective cognitive BDI” became the most important element, while KL and ROC methods resulted in “concentration difficulty” to have the highest rank. “Agitation” was selected to be the second most important element by KL and ROC criteria, while “concentration difficulty” was reported as the second element by MI. Considering the second set of features (only 21 items of BDI), all methods reported “concentration difficulty” to be the element with the highest rank. “Agitation” was selected as the second most relevant BDI element by KL and ROC, whereas “suicidal thoughts and wishes” were reported to be the second element regarding MI criterion. Discussion: These findings showed important role of cognitive dysfunction as the predictor rTMS in depressed patients. Keywords: Clinical predictor, Depressive disorder [0505] MODELING, TARGETING AND OPTIMIZING TRANSCRANIAL CURRENT STIMULATION (TCS)
MULTICHANNEL
G. Ruffini*1, M.D. Fox 2, E. Santarnecchi 2, P.C. Miranda 3, D. Edwards 4, F. Wendling 5, A. Pascual-Leone 2. 1 Neuroelectrics Corporation, USA; 2 Harvard Medical School, USA; 3 Universidade de Lisboa, Portugal; 4 BurkeCornell Medical Research Institute, USA; 5 INSERM, LTSI, France The electric field associated to transcranial currents or time-varying magnetic fields provides the first mechanistic link between non-invasive brain stimulation techniques and their physiological effects. More specifically, to first order, effects are a function of the magnitude and direction of the component of the electric field perpendicular to the cortical surface, as mediated by the coherent alteration of the trans-membrane potential in pyramidal neuron populations. We describe the creation of realistic head models to estimate cortical electric fields generated by tCS, their limitations, and the opportunity of using them to model and optimize the effects of stimulation, e.g., in computational models. We emphasize first the