Deep brain stimulation personalized solves a case of resistant depression

The depression, well treated, usually has a good prognosis, but for a minority of patients usual -fatherapy and psychotherapy treatments - are not effective.

Deep brain stimulation personalized solves a case of resistant depression

The depression, well treated, usually has a good prognosis, but for a minority of patients usual -fatherapy and psychotherapy treatments - are not effective. For them there are other options such as transcranial magnetic stimulation, electroconvulsative treatment and deep cerebral stimulation.

This last intervention, which consists of implementing electrodes through stereotactic surgery that send electrical impulses to specific structures of the brain, is employed routinely in certain patients with epilepsy, Parkinson's disease and also in certain psychiatric pathologies such as obsessive-convulsive disorder. In depression, the clinical trials that have been carried out -Scases until now - have concluded with some variability in the results.

Now a group of neurosurgeans and psychiatrists of the Weill Institute of Neuroscience at the University of California in San Francisco (UCSF) exposes in Nature Medicine the case of a 36-year-old woman with a resistant depression that debuted in childhood and who have managed to reverse Symptoms thanks to a "personalized" deep cerebral stimulation modality.

The technique (Closed-Loop), which has already been successfully used in epilepsy, is to identify specific patterns of brain activity in the concrete patient who correlate with their depressive symptoms, evaluated by the Hamilton depression scale.

Just as an instrument is refined before touching it, doctors refined the stimulation that were going to be applied in two steps: first, they determined by a brain mapping which areas of the patient were involved in the appearance of their symptoms, and later, they finely measured The intensity and frequency of the stimulation of the electrodes needed to alleviate these symptoms.

In this way, instead of applying a constant stimulation in a brain structure, they customized it to be activated when a brain activity pattern appears correlated with the depressive symptom. In the words of the first signer of this work, Katherine Scangos, during a presentation press conference, this "neuronal biomarker" has provided a "personalized treatment to a patient with depression to alleviate the symptoms of it." It is a type of precision neuromodulation that "had not been previously carried out in psychiatry".

The implantation of the device eliminated the symptoms immediately, in a manner, at least for 15 months, as reported in this study. Scangos, psychiatrist and neuroscientific, it also stands out that so far "no secondary effect has been experienced, although we are vigilant at the possible appearance of a worsening of depression or anxiety."

Sarah, the patient treated in this study, who also participated in the press conference, where he defined his daily "torture", in which he had to fight constantly with destructive thoughts, thus describes his sensations with the technique: "During The first months, the decrease in depression was so abrupt that I was not sure if it was going to last. But it has lasted.

And I have realized that the device reinforces the therapy and self-care I learned as a patient here at the UCSF. "That combination has given him a perspective on emotional triggers and irrational thoughts that used to obsess her." Now, "he says, "Those thoughts still arise, but it's just ... PUF ... The cycle stops."

This neurostimulation technique had already been previously employed in the treatment of epilepsy, explains the neurosurgeon of UCSF Edward Chang, for whom now they meet "almost all the key findings of our previous research in a single treatment destined to alleviate depression" . The also author of the work, the Psychiatrist of the UCSF Andrew Krystal, says that "the study points out the road to a new paradigm that is desperately needed in psychiatry".

Sarah's case is the first of a study that expects to expand with more patients. In the essay, another two patients have already been recorded and researchers hope to complete it with nine more.

"We need to observe how these circuits vary between patients and repeat this work several times. And we need to see if the biomarker or the cerebral circuit of an individual changes over time as the treatment continues," says Scangos.

For the Neurocirujana Cristina Torres, a specialist in the University Hospital of the Princess, center where deep cerebral stimulation is carried out to treat neuropsychiatric diseases, the case that has been communicated "is interesting to follow the line that has already been applied with good results Epilepsy ". The neurosurgeon exposes DM that identifying the amygdala as an area for stimulation "is a novelty".

On the personalization of the technique it could occur, comment, that "the electrode is placed in ten other people in the nuclei that have been determined in this patient and all works more or less as well as well. This is something that will have to explore the following studies ".

The expert considers that we must interpret the work with caution, because it does not stop being the experience with a single patient. "The truth is that deep cerebral stimulation works in resistant depression, although there is a certain reluctance to derive the patients, in part, by ignorance and by the shortage of double-blind controlled randomized studies, which are complex to perform with this treatment" .

In this coincides Gabriel Rubio, head of the Psychiatry Service of the University Hospital 12, who believes that more essays are needed on this therapy, which has obtained heterogeneous results. Rubio recalls that the recommendation of the US Regulatory Agency FDA establishes that in resistant depression - when they have failed three different pharmacological families - the following therapeutic strategy is "repetitive transcranial magnetic stimulation and if there is no improvement, the patient is a candidate for Electroconvulsive therapy or deep cerebral stimulation ".

Professor, with extensive experience in the use of transcranial magnetic stimulation, alludes to the age of the patient treated in the study, 36 years. "In general, patients with resistant depression tend to be older, probably because in most of the mental health centers of our country we usually leave too long before considering that diagnosis. That is why in recent years it is being done. Emphasize premium diagnosing the depression and do not let too long on detecting that a certain patient has resistant depression. "

Updated Date: 09 October 2021, 04:44

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