Closing the Loop on Deep Brain Stimulation for Treatment-Resistant Depression.
Closing the Loop on Deep Brain Stimulation for Treatment-Resistant Depression.
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DOI：
10.3389/fnins.2018.00175
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发表时间：
2018
影响因子：
4.3
通讯作者：
Dougherty DD
中科院分区：
文献类型：
--
作者：
Widge AS;Malone DA Jr;Dougherty DD
重度抑郁发作是导致精神残疾的最大原因，而且往往无法通过药物和心理治疗来治疗。对抑郁症的神经回路基础的理解的进步，加上脑深部电刺激（DBS）治疗运动障碍的成功，促使一些研究小组测试脑深部电刺激治疗难治性抑郁症。现在，在开放标签和盲法研究中，多个大脑部位受到了刺激。最初的开放标签结果是显著的，但后续的对照/盲法临床试验产生了不一致的结果，成功和失败都达到了终点。后续研究的数据表明，这是因为在这些试验中，DBS的目标不是达到生理反应。我们在技术生命周期框架内回顾这些结果，其中这些早期试验的“失败”是对不成熟技术过度热情的自然结果。该框架预测，从这个“幻灭之谷”开始，星展银行可能正接近一个“启蒙之坡”。具体来说，通过结合最近的机制见解和成熟的脑机接口（BCI）技术，下一代试验将能够更好地针对病理生理学。实现这一目标的关键将是开发闭环系统，该系统可以根据患者的个体表型半自主地改变刺激策略。这种新一代的DBS方法有望改善精神病学治疗。
Major depressive episodes are the largest cause of psychiatric disability, and can often resist treatment with medication and psychotherapy. Advances in the understanding of the neural circuit basis of depression, combined with the success of deep brain stimulation (DBS) in movement disorders, spurred several groups to test DBS for treatment-resistant depression. Multiple brain sites have now been stimulated in open-label and blinded studies. Initial open-label results were dramatic, but follow-on controlled/blinded clinical trials produced inconsistent results, with both successes and failures to meet endpoints. Data from follow-on studies suggest that this is because DBS in these trials was not targeted to achieve physiologic responses. We review these results within a technology-lifecycle framework, in which these early trial “failures” are a natural consequence of over-enthusiasm for an immature technology. That framework predicts that from this “valley of disillusionment,” DBS may be nearing a “slope of enlightenment.” Specifically, by combining recent mechanistic insights and the maturing technology of brain-computer interfaces (BCI), the next generation of trials will be better able to target pathophysiology. Key to that will be the development of closed-loop systems that semi-autonomously alter stimulation strategies based on a patient's individual phenotype. Such next-generation DBS approaches hold great promise for improving psychiatric care.
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影响因子：
10.6
作者：
Goodman WK;Foote KD;Greenberg BD;Ricciuti N;Bauer R;Ward H;Shapira NA;Wu SS;Hill CL;Rasmussen SA;Okun MS
通讯作者：
Okun MS
影响因子：
25
作者：
Gordon, Joshua A.
通讯作者：
Gordon, Joshua A.
影响因子：
3.5
作者：
Crowell AL;Garlow SJ;Riva-Posse P;Mayberg HS
通讯作者：
Mayberg HS
影响因子：
25.8
作者：
Grisanzio, Katherine A.;Goldstein-Piekarski, Andrea N.;Williams, Leanne M.
通讯作者：
Williams, Leanne M.
影响因子：
25.8
作者：
Bergfeld, Isidoor O.;Mantione, Mariska;Denys, Damiaan
通讯作者：
Denys, Damiaan