Deep Brain Stimulation for Depression Using Directional Current Steering and Individualized Network Targeting

使用定向电流引导和个性化网络目标进行深部脑刺激治疗抑郁症

基本信息

  • 批准号:
    10883136
  • 负责人:
  • 金额:
    $ 15.4万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2017
  • 资助国家:
    美国
  • 起止时间:
    2017-09-15 至 2026-02-28
  • 项目状态:
    未结题

项目摘要

ABSTRACT The public health burden of Treatment Resistant Depression (TRD) has prompted clinical trials of deep brain stimulation (DBS) that have, unfortunately, produced inconsistent outcomes. Potential gaps and opportunities include a need: (1) to better understand the neurocircuitry of the disease; (2) for precision DBS devices that can target brain networks in a clinically and physiologically validated manner; and (3) for greater insight into stimulation dose-response relationships. These needs are based on our overarching hypothesis that network- guided neuromodulation is critical for the efficacy of DBS in TRD. This project aims to address the unmet need of TRD patients by identifying brain networks critical for treating depression and to use next generation precision DBS with steering capability to engage these targeted networks and develop a new therapy for TRD. We use the Boston Scientific (BS) Vercise DBS system, which offers a segmented steerable lead with multiple independent current sources that allows true directional steering. Moreover, this system integrates stimulation field modeling (SFM) with MR tractography to predict network engagement. We use an innovative approach of targeting both subgenual cingulate (SGC) and ventral capsule/ventral striatum (VC/VS), which we term corticomesolimbic DBS. These targets are hubs in distinct yet partially overlapping depression networks and emerging basic science literature implicates them in bidirectional modulation of depression circuits. We also apply a paradigm-shifting approach using intracranial stereo-EEG (sEEG) subacutely after DBS implant to evaluate the clinical reliability of steering, SFMs, and tractography and to define and then target the networks mediating symptoms of depression. In Aim 1, in the Epilepsy Monitoring Unit (EMU), we investigate the capability of Vercise to selectively engage distinct brain networks and compare the spatial distribution of evoked network activity and modulation with that predicted by SFM and tractography. In Aim 2, we conduct further studies in the EMU to delineate depression-relevant networks and show behavioral changes with network-targeted stimulation. We use a variety of tasks to probe different symptom domains and novel assessment tools (Computerized Adaptive Testing and Automated Facial Affect Recognition) to enhance classification and model algorithms to optimize stimulation patterns. In Aim 3, we bring the results from Aims 1 and 2 together, to test the therapeutic potential of corticomesolimbic DBS in 12 subjects with TRD, with a focus on safety, feasibility, and preliminary efficacy in a 8-month open label trial with a subsequent randomized, blinded withdrawal of stimulation to assess efficacy. The impact of this proposal includes physiological validation of current “steering” DBS technology to target specific networks, insights into effects of stimulation parameters on network physiology, an improved understanding of the pathophysiology of depression, and, perhaps most importantly, a novel approach for treating TRD. This research will also pioneer a novel and high-yield test bed for DBS therapy development consistent with BRAIN priorities.
摘要

项目成果

期刊论文数量(0)
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Wayne K Goodman其他文献

Wayne K Goodman的其他文献

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{{ truncateString('Wayne K Goodman', 18)}}的其他基金

DEEP BRAIN STIMULATION FOR DEPRESSION USING DIRECTIONAL CURRENT STEERING AND INDIVIDUALIZED NETWORK TARGETING
使用定向电流引导和个性化网络目标进行深部脑刺激治疗抑郁症
  • 批准号:
    9564230
  • 财政年份:
    2017
  • 资助金额:
    $ 15.4万
  • 项目类别:
Deep Brain Stimulation for Depression Using Directional Current Steering and Individualized Network Targeting
使用定向电流引导和个性化网络目标进行深部脑刺激治疗抑郁症
  • 批准号:
    10704418
  • 财政年份:
    2017
  • 资助金额:
    $ 15.4万
  • 项目类别:
Neuroethics of aDBS Systems Targeting Neuropsychiatric and Movement Disorders
针对神经精神和运动障碍的 aDBS 系统的神经伦理学
  • 批准号:
    10002034
  • 财政年份:
    2017
  • 资助金额:
    $ 15.4万
  • 项目类别:
Adaptive DBS in Non-Motor Neuropsychiatric Disorders: Regulating Limbic Circuit Imbalance
非运动神经精神疾病的适应性 DBS:调节边缘回路不平衡
  • 批准号:
    10451827
  • 财政年份:
    2016
  • 资助金额:
    $ 15.4万
  • 项目类别:
Adaptive DBS in Non-Motor Neuropsychiatric Disorders: Regulating Limbic Circuit Imbalance
非运动神经精神疾病的适应性 DBS:调节边缘回路不平衡
  • 批准号:
    9769905
  • 财政年份:
    2016
  • 资助金额:
    $ 15.4万
  • 项目类别:
Adaptive DBS in Non-Motor Neuropsychiatric Disorders: Regulating Limbic Circuit Imbalance
非运动神经精神疾病的适应性 DBS:调节边缘回路不平衡
  • 批准号:
    10210305
  • 财政年份:
    2016
  • 资助金额:
    $ 15.4万
  • 项目类别:
Combined Psychiatry Residency and PhD Training at Mount Sinai
西奈山精神病学住院医师培训和博士培训相结合
  • 批准号:
    8854147
  • 财政年份:
    2013
  • 资助金额:
    $ 15.4万
  • 项目类别:
PILOT STUDY OF DBS FOR TREATMENT-REFRACTORY OCD
DBS 治疗难治性强迫症的试点研究
  • 批准号:
    7717076
  • 财政年份:
    2007
  • 资助金额:
    $ 15.4万
  • 项目类别:
SSRI-Induced Activation Syndrome In Pediatric OCD
SSRI 诱导的儿童强迫症激活综合征
  • 批准号:
    7162453
  • 财政年份:
    2006
  • 资助金额:
    $ 15.4万
  • 项目类别:
PILOT STUDY OF DBS FOR TREATMENT-REFRACTORY OCD
DBS 治疗难治性强迫症的试点研究
  • 批准号:
    7605447
  • 财政年份:
    2006
  • 资助金额:
    $ 15.4万
  • 项目类别:

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