Track topics on Twitter Track topics that are important to you
Transcranial magnetic stimulation (TMS) therapy has proven to lead to symptom improvement in many individuals with major depressive disorder (MDD), yet there is heterogeneity in outcome, with some patients showing robust remission and other showing minimal symptom change. Identifying which individuals are likely to benefit from TMS therapy early in the course of treatment would support continued treatment for those predicted to do well, and consideration of alternative treatments for others individuals. This study will test specific hypotheses about the relationships between early neurophysiologic changes and later clinical outcome with TMS treatment.
A critical challenge in the management of major depressive disorder (MDD) is the selection of treatment for each individual patient. Although treatments with depression can restore people's lives, with any treatment modality there are some individuals who do not achieve complete remission of symptoms, whether the intervention is pharmacological, psychological, or somatic. While predictors for some treatments have been proposed for groups of patients, the translation of these predictors to individualized patient care has remained elusive. In an analysis of data from the NCT 00104611 multi-site, randomized, sham-controlled trial of TMS, it was found that a larger number of prior treatment failures, longer duration of the current episode, and the presence of comorbid anxiety were individual patient characteristics associated with poorer acute outcomes with TMS treatment in the randomized period (Lisanby et al., in press). This publication did not report standard predictor metrics (e.g., sensitivity, specificity, positive- or negative-predictive accuracy, ROC curves), so it is difficult to assess the value of these clinical factors in treatment planning for individual patients. A predictor that could distinguish between individuals likely to remit with TMS versus those likely to need a different intervention would be of great use to clinicians and patients in making treatment decisions.
Our prior work (Cook et al., 2001, 2002, 2005; Leuchter et al. 2002) has studied a new physiologic biomarker of response to SSRI and mixed-action antidepressants. The EEG-based cordance biomarker can detect the physiologic effects of successful antidepressant treatment at 48 hours, 1 week, and 2 weeks of treatment; in contrast, symptom differences between responders and non-responders did not separate until 4 weeks of treatment in our placebo-controlled trials. Additionally, the magnitude of early physiologic change was associated with the completeness of clinical response. Our biomarker has been independently studied and our findings replicated (Kopecek et al., 2006; Bareš et al., 2007, 2008). The cordance biomarker can be considered as a leading indicator or predictor of treatment outcome. As a non-invasive probe of brain physiology, it may detect early neurophysiologic changes associated with accelerated clinical response from TMS.
More recent work with a related EEG-based measure, the Antidepressant Treatment Response Index (ATR) has led to a simplified monitoring system; a physician can record clinically-useful data from a 15-minute in-office procedure with electrodes located on the forehead and ears (Leuchter et al., in submission). The ATR uses physiologic data collected prior to treatment and after one week of exposure, and was shown to be predictive of outcome with antidepressant medication. We are able to assess both cordance and ATR measures with EEG measurements made prior to treatment and after 5 treatment sessions with TMS to evaluate the predictive properties of both metrics.
On a related issue, some of the variation in outcome may be related to treatment factors. Quantitative models and direct in vivo measurements (Wagner et al, 2004, 2008) indicate that the electrical currents induced by TMS are predominantly confined to a brain region directly under the treatment coil. The procedure for positioning the coil over the cortical target is described in the NeuroStar TMS System User Manual (volume 2, sections 6 and 7) and involves first determining a location where stimulation leads to a contraction of the abductor policis brevis muscle (visualized with a thumb twitch on the right hand) and then positioning the coil 5.5 cm anterior to that position along the left Superior Oblique Angle line. While this target can be located with good reproducibility and was associated with therapeutic outcome in the NCT trial, it is not clear that this positions the coil over the best target within the DLPFC for all patients. Indeed, individual differences in gyral anatomy and in gross brain size both add variability to the specific neuroanatomic region being stimulated, and this may impact treatment efficiency.
Exposure to even a brief train of TMS pulses can elicit an acute physiologic change (cf Siebner and Rothwell, 2003), and so a test procedure can be performed that will assess the distance from the standard treatment position to the point eliciting a maximal acute physiologic response. We propose a 9-locus mapping procedure, involving the assessment of changes in brain activity from stimulation at locations including and around the standard treatment target. The nine locations will be the usual treatment location and 8 other points, 1.5 and 3.0 cm anterior, posterior, rostral, and caudal of the primary target. Test stimulation will be for 15 seconds (=150 pulses @ 10 Hz) at each location, followed by 5 minutes of continuous EEG recording to examine acute changes in regional brain activity in response to a brief stimulation exposure. All therapeutic stimulations will take place in the standard location, and we will be able to evaluate what proportion of variance in clinical outcome is explained by distance from the location of maximal acute physiologic response.
Based on these previous studies, we propose to assess patients during treatment with TMS, using clinical symptom ratings and brain physiology with EEG.
Control: Uncontrolled, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Transcranial Magnetic Stimulation
UCLA Depression Research and Clinic Program
University of California, Los Angeles
Published on BioPortfolio: 2014-08-27T03:20:09-0400
The purpose of this study is to determine whether repetitive high field transcranial magnetic stimulation of the left or right frontal lobes is beneficial for the treatment of depression t...
The study examines efficacy of repetitive transcranial magnetic stimulation in treating severely depressed patients who are medicated.
Repetitive transcranial magnetic stimulation (rTMS) has been recently FDA approved for the treatment of resistant depression. No accordance exists on which are the involved mechanisms of a...
This study will be comprised of two Phases. Phase 1 is a randomized, double-blinded study testing repetitive Transcranial Magnetic Stimulation (rTMS) versus sham (20 treatments over 4 week...
This study will evaluate the safety and effectiveness of magnetic brain stimulation for the treatment of major depression in depressed adults with moderate treatment resistance.
Repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. In this study we investigated whether the depression-related insomnia is modulated by this therapeutic method.
Repetitive transcranial magnetic stimulation (rTMS) is a new type of physiotherapy technology that has been widely used in the research of depression. Although many clinical trials have found that com...
The purpose of this study was to evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on suicidal ideation in patients with treatment-resistant major depression (TRD) (patients ...
The subgenual anterior cingulate cortex (sgACC) has been implicated in major depressive disorder (MDD), and this study evaluated sgACC connectivity before and after repetitive transcranial magnetic st...
Depressive disorder is one of the most common mental health problems currently. However, the mechanism-based treatments for this disorder remain elusive. Repetitive transcranial magnetic stimulation (...
The electrical response evoked in a muscle or motor nerve by electrical or magnetic stimulation. Common methods of stimulation are by transcranial electrical and TRANSCRANIAL MAGNETIC STIMULATION. It is often used for monitoring during neurosurgery.
Measurable changes in activities in the CEREBRAL CORTEX upon a stimulation. A change in cortical excitability as measured by various techniques (e.g., TRANSCRANIAL MAGNETIC STIMULATION) is associated with brain disorders.
A technique of brain electric stimulation therapy which uses constant, low current delivered via ELECTRODES placed on various locations on the scalp.
A technique that involves the use of electrical coils on the head to generate a brief magnetic field which reaches the CEREBRAL CORTEX. It is coupled with ELECTROMYOGRAPHY response detection to assess cortical excitability by the threshold required to induce MOTOR EVOKED POTENTIALS. This method is also used for BRAIN MAPPING, to study NEUROPHYSIOLOGY, and as a substitute for ELECTROCONVULSIVE THERAPY for treating DEPRESSION. Induction of SEIZURES limits its clinical usage.
A persistent activity-dependent decrease in synaptic efficacy between NEURONS. It typically occurs following repeated low-frequency afferent stimulation, but it can be induced by other methods. Long-term depression appears to play a role in MEMORY.
Alternative Medicine Cleft Palate Complementary & Alternative Medicine Congenital Diseases Dentistry Ear Nose & Throat Food Safety Geriatrics Healthcare Hearing Medical Devices MRSA Muscular Dyst...
Anxiety is caused by stress. It is a natural reaction, and is beneficial in helping us deal with tense situations and pressure. It is deterimental when is becomes an excessive, irrational dread of everyday situations. The most common types of anxiety di...