best brain stimulation treatment for mental illnesses by liam phelan
TRANSCRIPT
BEST BRAIN BEST BRAIN STIMULATION STIMULATION
TREATMENT FOR MENTAL TREATMENT FOR MENTAL ILLNESSESILLNESSES
By Liam PhelanBy Liam Phelan
THE PROBLEMTHE PROBLEM
• Major Depressive Disorder: MDD effects approximately 9.9million American Major Depressive Disorder: MDD effects approximately 9.9million American
adults.adults.
• If not properly treated it can become treatment-resistant depression.If not properly treated it can become treatment-resistant depression.
• There are estimated 7-10million people world wide who suffer from There are estimated 7-10million people world wide who suffer from
Parkinson’s Disease.Parkinson’s Disease.
• There are 60,000 Americans diagnosed each year with Parkinson’s.There are 60,000 Americans diagnosed each year with Parkinson’s.
http://www.pdf.org/en/parkinson_statisticshttp://www.miraresearch.org/understanding/statistics/
BRAIN STIMULATION THERAPIESBRAIN STIMULATION THERAPIES
• There are three main types of brain stimulation therapies:There are three main types of brain stimulation therapies:
• Electrocompulsive Therapy (ECT)Electrocompulsive Therapy (ECT)
• Transcranial Magnetic Stimulation (TMS)Transcranial Magnetic Stimulation (TMS)
• Deep Brain Stimulation (DBS)Deep Brain Stimulation (DBS)
• A subfield of this is transcranial Direct Current Stimulation (tDCS)A subfield of this is transcranial Direct Current Stimulation (tDCS)
ELECTROCOMPULSIVE THERAPY (ECT)ELECTROCOMPULSIVE THERAPY (ECT)
• Used to treat depressionUsed to treat depression
• Can use one diode (unilateral) or two Can use one diode (unilateral) or two diodes (bilateral) which are placed on diodes (bilateral) which are placed on scalp in target areas.scalp in target areas.
• Patients are put under with anesthia Patients are put under with anesthia and given a muscle relaxerand given a muscle relaxer
• Patients are shocked for around a Patients are shocked for around a minute.minute.
• Multiple sessions needed to treatMultiple sessions needed to treat
http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml#Fitzgerald
Side Effects•Headache•Muscle ache•Upset stomach•Short termmemory issues
TRANSCRANIAL MAGNETIC STIMULATION TRANSCRANIAL MAGNETIC STIMULATION (TMS)(TMS)
• Used to treat depressionUsed to treat depression
• Electromagnet placed over target Electromagnet placed over target
areaarea
• Stimulus sent to electromagnet in Stimulus sent to electromagnet in
pulsespulses
• Treatment lasts ~40 minutesTreatment lasts ~40 minutes
• Only a few sessions neededOnly a few sessions needed
Side Effects•Headache•Muscle contractions in face and jaw•discomfort•Lightheadedness
http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml#Fitzgerald
DEEP BRAIN STIMULATION (DBS)DEEP BRAIN STIMULATION (DBS)
• Used to treat Parkinson’s and Used to treat Parkinson’s and
most recently used in depression most recently used in depression
trialstrials
• Two electrodes implanted in brainTwo electrodes implanted in brain
(generally at motor cortexes)(generally at motor cortexes)
• Pulse generator implanted in chest, Pulse generator implanted in chest,
sends constant pulse to electrodessends constant pulse to electrodes
http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml#Fitzgerald
Side Effects•Surgical liabilities•Unwanted moodchanges•Movement disorders•Lightheadedness•Trouble sleeping
TREMTEX STIMBANDTREMTEX STIMBAND
• Used to treat Parkinson’s diseaseUsed to treat Parkinson’s disease
• Uses transcranial Direct Current Uses transcranial Direct Current
StimulationStimulation
• Electrodes placed over motor Electrodes placed over motor
cortexescortexes
• Used in 20 minute periods dailyUsed in 20 minute periods daily
• Stimband not tested on humans yet, Stimband not tested on humans yet,
tDCS however has beentDCS however has been
http://www.baltimoresun.com/health/maryland-health/bs-hs-parkinsons-device-20150716-story.html
http://hub.jhu.edu/2015/06/10/stimband-brain-stimulator
http://www.bme.jhu.edu/news-events/news-highlights.php?id=510
Side Effects of tDCS•Headache•Lightheadedness•Nausea
https://en.wikipedia.org/wiki/Transcranial_direct-current_stimulation#Side_effects_of_stimulation
ECT DATAECT DATA
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905244/
TMS DATATMS DATA
http://archpsyc.jamanetwork.com/article.aspx?articleid=207938
DBS DATADBS DATAPatient # 1 2 3 4 5 6 GroupGender F M F M M F 3F/3MCurrent age
48 59 45 48 37 39 46 ± 8
Age MDD onset
18 45 21 40 19 34 29.5 ± 12
Current episode (yrs)
1.5 3 6 8 10 5 5.6 ± 3
# Lifetime episodes
12 9 3 1 2 1 4.7 ± 5
Hamilton depression score (17 item)
29 20 27 24 26 25 25 ± 3
Past ECT no yes yes yes yes yes 5 of 6Past psychotherapy
yes yes yes yes yes yes 6 of 6
Family history MDD
yes no yes yes yes yes 5 of 6
DSM IV diagnosis
UP BPII UP UP UP UP 5 UP
Melancholic subtype
yes no yes no yes yes 4 of 6
Current medicationsa
1–5 1, 3 1–4 1, 2, 4, 6, 7
1, 7 1, 4, 5, 7
Time Hamilton Scorea
Pt 1b Pt 2c Pt 3b Pt 4c Pt 5b Pt 6b
Preop baseline
29 22 29 24 26 25
1 week postop (acute stimulation)
5 10 12 18 17 12
2 weeks postop (DBS off)
9 13 23 18 22 n/a
1 month 10 14 17 20 22 12
2 months 13 11 12 18 10 12
3 months 2 15 14 25 7 14
4 months 4 9 12 24 6 12
5 months 5 18 7 23 8 n/a
6 months 5 15 9 23 6 12
http://www.sciencedirect.com/science/article/pii/S089662730500156X
STIMBAND DATASTIMBAND DATA
https://youtu.be/vrpVYfQaevw?t=2m59s
RESULTS AND COMPARISONRESULTS AND COMPARISON
• ECT is still very effective, probably the best option for what it can treat.ECT is still very effective, probably the best option for what it can treat.
• TMS has little to no effect on individuals suffering from depression.TMS has little to no effect on individuals suffering from depression.
• Use of DBS for Parkinson’s is costly and ineffectiveUse of DBS for Parkinson’s is costly and ineffective
• However, it use to cure MDD is very promisingHowever, it use to cure MDD is very promising
• The stimband and use of tDCS is very promising towards the control of The stimband and use of tDCS is very promising towards the control of
Parkinson’s symptoms, and is the best Brain Stimulation treatment for that Parkinson’s symptoms, and is the best Brain Stimulation treatment for that
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QUESTIONS?QUESTIONS?