Breaking News
October 19, 2018 - Conceptual framework proposed to examine role of exercise in multiple sclerosis
October 19, 2018 - Near infrared spectroscopy technique for accurate evaluation of chondral injuries
October 19, 2018 - Shorter physician encounters associated with antibiotic prescribing
October 19, 2018 - In the Spotlight: Enjoying research and exploring opportunities
October 19, 2018 - Physical activity lowers cardiovascular mortality risk in frail older adults
October 19, 2018 - New imaging tool helps visualize how sound-induced vibrations travel through the ear
October 19, 2018 - Key insights into the application, production of bioactive materials
October 19, 2018 - New urea sorbent could speed up the development of wearable artificial kidney
October 19, 2018 - Intensive care patients’ muscles less able to use fats for energy
October 19, 2018 - FDA Advisory Committee Recommends Approval of Dsuvia for the Treatment of Moderate-to-Severe Acute Pain
October 19, 2018 - 48,XXXY syndrome – Genetics Home Reference
October 19, 2018 - Physical exercise improves the elimination of toxic proteins from muscles
October 19, 2018 - How a new system improved wait times for Stanford kidney transplant patients
October 19, 2018 - Nutrition has bigger positive impact on bone mass and strength than exercise
October 19, 2018 - Study finds lack of progress in media representation of nurses over last 20 years
October 19, 2018 - Many people have trouble understanding differences between OCD and OCPD
October 19, 2018 - New family planning app found to be as effective as modern methods
October 19, 2018 - Gastric Banding, Metformin Similar for Improving Glycemia
October 19, 2018 - Physiologist publishes findings on the role of the protein titin in muscle contraction
October 19, 2018 - What digital health companies need to do to succeed
October 19, 2018 - N. Carolina Sees Alarming Spike in Heart Infections Among Opioid Users
October 19, 2018 - Video monitoring of TB therapy works well in urban and rural areas
October 19, 2018 - Determining acid-neutralizing capacity for OTC antacids
October 19, 2018 - Males who spend more time taking care of kids have greater reproductive success
October 18, 2018 - Study to explore bioethics of brain organoids
October 18, 2018 - Environmental conditions may drive development of multiple sclerosis
October 18, 2018 - Genetically modifying zebrafish provides more accurate disease models
October 18, 2018 - Purdue Pharma, Eisai announce positive topline results from Phase 3 study of lemborexant
October 18, 2018 - 5 Strength-Training Mistakes to Avoid
October 18, 2018 - Immune system’s balancing act keeps bowel disease in check
October 18, 2018 - Anti-inflammatory drug effective for treating lymphedema symptoms | News Center
October 18, 2018 - Keeping Your Voice Young
October 18, 2018 - One-time universal screening recommended to tackle increase in hepatitis C
October 18, 2018 - Researchers to develop new stem cell-based strategies for treating vision disorders
October 18, 2018 - Detecting epigenetic signature may help people stay ahead of inflammatory bowel disease
October 18, 2018 - Understanding AFib: Slowing down the dancing heart
October 18, 2018 - Using NMR to Reduce Fraud
October 18, 2018 - New automated model identifies dense breast tissue in mammograms
October 18, 2018 - Mysterious polio-like illness baffles medical experts while frightening parents
October 18, 2018 - Cases of Acute Flaccid Myelitis on the rise across U.S.
October 18, 2018 - Dietary fiber reduces brain inflammation during aging
October 18, 2018 - New tool could help prioritize recovery efforts for the poorest hit by natural disasters
October 18, 2018 - Hundreds of dietary supplements shown to contain unapproved drugs
October 18, 2018 - Active Pharmaceuticals ID’d in >700 Dietary Supplements
October 18, 2018 - Cell death protein also damps inflammation
October 18, 2018 - AI pathology diagnostic tool developed using deep learning technology from Olympus
October 18, 2018 - Health Highlights: Oct. 15, 2018
October 18, 2018 - Largest study of ‘post-treatment controllers’ reveals clues about HIV remission
October 18, 2018 - Bad Blood in Silicon Valley: A conversation with John Carreyrou
October 18, 2018 - ANTRUK’s Annual Lecture sends out message on shortage of funds for antibiotic research
October 18, 2018 - NAM special publication outlines steps to ensure interoperability of health care systems
October 18, 2018 - Novel method uses just a drop of blood to monitor effect of lung cancer therapy
October 18, 2018 - New blood test could spare cancer patients from unnecessary chemotherapy
October 18, 2018 - Training young researchers to work with data volumes arising in the health sector
October 18, 2018 - New Metrohm IC method is reliable and convenient to use for zinc oxide assay
October 18, 2018 - Global AIDS, TB fight needs more money: health fund
October 18, 2018 - Understanding the forces that cause sports concussions
October 18, 2018 - Research points to new target for treating periodontitis
October 18, 2018 - New tool improves assessment of postpartum depression symptoms
October 18, 2018 - From Biopsy to Diagnosis
October 18, 2018 - Sexual harassment and assault linked to worse physical/mental health among midlife women
October 18, 2018 - Stumped by medical school? A Q&A with a learning specialist
October 18, 2018 - Report predicts life expectancy in 2040, Spain comes out on top
October 18, 2018 - Self-lubricating condoms may help raise condom usage
October 18, 2018 - Targeting immune checkpoints in microglia could reduce out-of-control neuroinflammation
October 18, 2018 - Study finds changes in antiepileptic drug metabolism during different trimesters of pregnancy
October 18, 2018 - Autonomic nervous system directly controls stem cell proliferation, study shows
October 18, 2018 - FDA Approves Talzenna (talazoparib) for gBRCAm HER2-Negative Locally Advanced or Metastatic Breast Cancer
October 18, 2018 - Sleeping Beauty technique helps identify genes responsible for NAFLD-associated liver cancer
October 18, 2018 - Many U.S. adults confused about primary care, study shows
October 18, 2018 - UC researcher focuses on light-mediated therapies to target breast cancer
October 18, 2018 - With philanthropic gifts, Stanford poised to make major advances in neurosciences | News Center
October 18, 2018 - Mice study shows antibiotics are not always necessary to cure sepsis
October 18, 2018 - Researchers discover why heart contractions are weaker in individuals with HCM
October 18, 2018 - Participation in organized sport during childhood may have long-term skeletal benefits
October 18, 2018 - Probiotic/antibiotic combination could eradicate drug-resistant bacteria
October 17, 2018 - More Socioeconomic Challenges for Hispanic Women With HIV
October 17, 2018 - 49,XXXXY syndrome – Genetics Home Reference
October 17, 2018 - Scientists uncover possible new causes of Tourette syndrome
October 17, 2018 - Girl undergoes unusual heart surgery after compassionate-use exemption | News Center
Deep brain stimulation offers relief to UTHealth patient with treatment-resistant depression

Deep brain stimulation offers relief to UTHealth patient with treatment-resistant depression

image_pdfDownload PDFimage_print

For Shannon Paige McCann, the thought of having brain surgery – which would frighten most – paled in significance to the depression that had dragged her down most of her life.

McCann was one of the first people in North America to undergo an experimental treatment option for people struggling with treatment-resistant depression (TRD). The pilot study at the Center of Excellence on Mood Disorders at The University of Texas Health Science Center at Houston (UTHealth) is using deep brain stimulation (DBS) for patients with chronic TRD. The procedure targets an area of the brain called the medial forebrain bundle, which is thought to be important for reward processing.

DBS has actually been used for decades to help Parkinson’s patients whose tremors did not improve with medication, said Jair Soares, M.D., Ph.D., principal investigator, director of the center and professor and Pat R. Rutherford, Jr. Chair in Psychiatry at the McGovern Medical School at UTHealth. DBS targeting the medial forebrain bundle has also been successfully used, on an experimental basis, to treat TRD in Germany. The UTHealth trial is approved by the U.S. Food and Drug Administration (FDA).

McGann, a patient in her late 40s who enrolled in the pilot study, described the treatment as “a miracle.”

“I felt like someone turned on a lightbulb in my brain. Everything is brighter. It changed my life,” she said.

Since she was a child, McGann has suffered from depression off and on. She was diagnosed with depression as a college freshman and was stabilized with medications. She went on to become a teacher for seven years, but after getting a new teaching position, her depression returned severely.

After that, McGann switched careers and excelled in pharmaceutical sales. Then, in 2007, her mother died and her boyfriend broke up with her -; and she hit a new low. “It was a chore to get out of bed; I would lay in bed for days,” she said.

Thinking another change might be beneficial, she moved from Virginia to Houston in September 2016 to take a new job. However, she wasn’t able to handle it. At that point, no medications were working for her and she did not respond to electroconvulsive therapy.

Since these treatments weren’t effective, McGann says one of her doctors in Virginia told her about the UTHealth DBS trial and recommended it to her. The small trial, which is enrolling 10 patients, is studying whether DBS of the medial forebrain bundle is safe and effective.

In the procedure, a neurosurgeon permanently implants two electrodes that each have four small contacts, which deliver electrical stimulation to the target area.

McGann said she wasn’t scared to undergo the treatment. “I had exhausted all other options,” she said.

Candidates for the treatment undergo a screening evaluation to determine if they meet the criteria for the study. This includes a thorough examination of their medical history, neuropsychological testing, bloodwork, drug screening and a physical. Patients in the trial undergo the procedure at Memorial Hermann-Texas Medical Center.

The procedure involves the surgeon making an incision across the front of the head and drilling two holes down to the skull. Then, the surgeon places the electrodes and turns them on. The patient is kept awake during this time. But they don’t experience any pain because local anesthetic is used, and there are no pain receptors in the brain, said Albert Fenoy, M.D., associate professor at the Vivian L. Smith Department of Neurosurgery at McGovern Medical School at UTHealth and a member of the Mischer Neuroscience Institute at Memorial Hermann-TMC.

“Patients need to be awake because we ask them questions to assess their mood and feelings while we test the electrodes at different spots in order to find the one which improves mood to the highest extent, Fenoy said. “We will note changes in the patient’s energy or motivation, such as speaking more freely, smiling or laughing. That indicates that we are in the right spot. It is amazing to see, because it is provoked by the stimulation.”

Once that is complete, the patient is placed under anesthesia while a wire that connects the electrodes and a battery pack (called the neurostimulator) are implanted underneath the skin. The neurostimulator -; the system’s power source -; is placed inside a metal case below the clavicle. Similar to a small pacemaker, models range from 2 to 3 inches in diameter and are about 1/2 inch thick. The battery produces the electrical impulses needed to stimulate the electrodes.

McGann said she felt immediate relief when the surgery was over. She stayed in the hospital one night and went home the next day. “I remember wanting to do things, like going to the pool at my apartment complex, which I had no desire to do before,” she said.

Follow-up care includes visits with a neurosurgeon and a psychiatrist, who monitors improvement in depressive symptoms every week by having them rate their level of depression. Patients also have a neuropsychological evaluation once a year to ensure that DBS is not interfering with brain functions, such as memory. The study follows patients for at least two years after surgery.

Patients may not experience immediate symptom suppression from DBS. Frequent, non-invasive adjustment to the stimulation parameters may be required.

“The procedure is very experimental, so there’s no guarantee that someone will get better,” Soares said. “But the goal is to see patients get better. Because depression is a chronic condition, patients may have still bumps along the road. But hopefully their lows won’t be as low, and they won’t last as long. We hope to see an uptrend in the patient’s mood, and that they have normal energy and enthusiasm for life.”

Soares notes that in past decades DBS treatment was used to treat patients with depression who didn’t respond to commonly available treatments -; but different areas of the brain were targeted and it didn’t prove to be effective.

During a preliminary study published in 2013 and conducted in Germany at University Hospital Bonn, researchers targeted a new area of the brain -; the medial forebrain bundle -; with success. Six of the seven patients in the study experienced a positive response for at least 24 months after their surgery.

Inspired by the German study, Soares, chair of the Department of Psychiatry and Behavioral Health, paired up with faculty at the Vivian L. Smith Department of Neurosurgery at McGovern Medical School to design their own trial. To date, UTHealth has performed nine surgeries. “We are very impressed with the results so far,” he said. “Patients are functioning better. Some are now working full-time and are enjoying life with their families.”

If the trial continues to be successful, UTHealth researchers plan to ask the FDA to approve a study with a larger group of patients over a longer period of time. “For now, we are just trying to replicate and expand what our German colleagues reported,” Soares said.

Fenoy said the ultimate goal would be to have the FDA approve this treatment for TRD, so others can benefit. “It’s amazing to see patients who have been in a rut for years go back to a normal way of life,” he said.

“To find something that would help people who have run out of hope would be a major treatment advancement for TRD,” Soares said.

Tagged with:

About author

Related Articles