Nolan R Williams1, E Baron Short2, Thomas Hopkins2, Brandon S Bentzley3, Greg L Sahlem2, Jaspreet Pannu3, Matt Schmidt2, Jeff J Borckardt2, Jeffrey E Korte4, Mark S George5, Istvan Takacs6, Ziad Nahas7. 1. Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA. Electronic address: nolanw@stanford.edu. 2. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA. 3. Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA, USA. 4. Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA. 5. Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA; Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA; Ralph H. Johnson VA Medical Center, Charleston, SC, USA. 6. Department of Neurosciences, Medical University of South Carolina, Charleston, SC, USA. 7. American University of Beirut Medical Center, Beirut, Lebanon.
Abstract
BACKGROUND: Epidural prefrontal cortical stimulation (EpCS) represents a novel therapeutic approach with many unique benefits that can be used for treatment-resistant depression (TRD). OBJECTIVE: To examine the long-term safety and efficacy of EpCS of the frontopolar cortex (FPC) and dorsolateral prefrontal cortex (DLPFC) for treatment of TRD. METHODS: Adults (N = 5) who were 21-80 years old with severe TRD [failure to respond to adequate courses of at least 4 antidepressant medications, psychotherapy and ≥20 on the Hamilton Rating Scale for Depression (HRSD24)] were recruited. Participants were implanted with bilateral EpCS over the FPC and DLPFC and received constant, chronic stimulation throughout the five years with Medtronic IPGs. They were followed for 5 years (2/1/2008-10/14/2013). Efficacy of EpCS was assessed with the HRSD24 in an open-label design as the primary outcome measure at five years. RESULTS: All 5 patients continued to tolerate the therapy. The mean improvements from pre-implant baseline on the HRSD24 were [7 months] 54.9% (±37.7), [1 year] 41.2% (±36.6), [2 years] 53.8% (±21.7), and [5 years] 45% (±47). Three of 5 (60%) subjects continued to be in remission at 5 years. There were 5 serious adverse events: 1 electrode 'paddle' infection and 4 device malfunctions, all resulting in suicidal ideation and/or hospitalization. CONCLUSION: These results suggest that chronic bilateral EpCS over the FPC and DLPFC is a promising and potentially durable new technology for treating TRD, both acutely and over 5 years.
BACKGROUND: Epidural prefrontal cortical stimulation (EpCS) represents a novel therapeutic approach with many unique benefits that can be used for treatment-resistant depression (TRD). OBJECTIVE: To examine the long-term safety and efficacy of EpCS of the frontopolar cortex (FPC) and dorsolateral prefrontal cortex (DLPFC) for treatment of TRD. METHODS: Adults (N = 5) who were 21-80 years old with severe TRD [failure to respond to adequate courses of at least 4 antidepressant medications, psychotherapy and ≥20 on the Hamilton Rating Scale for Depression (HRSD24)] were recruited. Participants were implanted with bilateral EpCS over the FPC and DLPFC and received constant, chronic stimulation throughout the five years with Medtronic IPGs. They were followed for 5 years (2/1/2008-10/14/2013). Efficacy of EpCS was assessed with the HRSD24 in an open-label design as the primary outcome measure at five years. RESULTS: All 5 patients continued to tolerate the therapy. The mean improvements from pre-implant baseline on the HRSD24 were [7 months] 54.9% (±37.7), [1 year] 41.2% (±36.6), [2 years] 53.8% (±21.7), and [5 years] 45% (±47). Three of 5 (60%) subjects continued to be in remission at 5 years. There were 5 serious adverse events: 1 electrode 'paddle' infection and 4 device malfunctions, all resulting in suicidal ideation and/or hospitalization. CONCLUSION: These results suggest that chronic bilateral EpCS over the FPC and DLPFC is a promising and potentially durable new technology for treating TRD, both acutely and over 5 years.
Authors: Nolan R Williams; Keith D Sudheimer; Brandon S Bentzley; Jaspreet Pannu; Katy H Stimpson; Dalton Duvio; Kirsten Cherian; Jessica Hawkins; Kristen H Scherrer; Benjamin Vyssoki; Danielle DeSouza; Kristin S Raj; Jennifer Keller; Alan F Schatzberg Journal: Brain Date: 2018-03-01 Impact factor: 13.501
Authors: Laleh Golestanirad; John T Gale; Nauman F Manzoor; Hyun-Joo Park; Lyall Glait; Frederick Haer; James A Kaltenbach; Giorgio Bonmassar Journal: Front Physiol Date: 2018-07-27 Impact factor: 4.566
Authors: Sarah T Olsen; Ishita Basu; Mustafa Taha Bilge; Anish Kanabar; Matthew J Boggess; Alexander P Rockhill; Aishwarya K Gosai; Emily Hahn; Noam Peled; Michaela Ennis; Ilana Shiff; Katherine Fairbank-Haynes; Joshua D Salvi; Cristina Cusin; Thilo Deckersbach; Ziv Williams; Justin T Baker; Darin D Dougherty; Alik S Widge Journal: Front Hum Neurosci Date: 2020-10-23 Impact factor: 3.169
Authors: Evan M Dastin-van Rijn; Seth D König; Danielle Carlson; Vasudha Goel; Andrew Grande; Donald R Nixdorf; Sarah Benish; Alik S Widge; Ziad Nahas; Michael C Park; Tay I Netoff; Alexander B Herman; David P Darrow Journal: Brain Sci Date: 2021-12-26