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Deep Brain Stimulation

Deep Brain Stimulation. A New Treatment for Treatment-Resistant Depression. Michael Lindsey suffered for years with severe, treatment-resistant depression Tried every available fix 20 different medications 16 electroshock treatments Endless talk therapy Nothing worked. Nothing worked ….

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Deep Brain Stimulation

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  1. Deep Brain Stimulation A New Treatment for Treatment-Resistant Depression

  2. Michael Lindsey suffered for years with severe, treatment-resistant depression Tried every available fix 20 different medications 16 electroshock treatments Endless talk therapy Nothing worked Nothing worked … www.dispatch.com

  3. Underwent deep brain stimulation surgery in a final attempt to regain his life Awake during the procedure, Michael laughed for the first time in years … until DBS www.dispatch.com

  4. Deep Brain Stimulation (DBS) • Used successful on thousands with Parkinson’s disease • Fixes malfunctioning brain systems via direct electrical stimulation • Excites very specific targets • Reversible and adjustable • Not FDA-approved for treatment-resistant depression yet but initial trials are promising www.henryfordhealth.org

  5. What is depression? • A disease of the brain • Involves a person’s physiology, biochemistry, mood, thoughts and behavior • Severe depressive symptoms without mania • a/k/a “major depression” or “major depressive disorder” www.dreamstime.com

  6. Treatment-ResistantDepression (TRD) • “Major depressive disorder” that just won’t go away • Severe depressive symptoms • Lasts months or years • Resists all standard treatments • Antidepressants • Talk Therapies • ECT http://www.neptunecowboy.com

  7. Grim Statistics • 17% of the U.S. population will experience major depressive disorder in their lifetime www.fims.uwo.ca

  8. Grim Statistics • Only 37% of those that seek treatment achieve full remission from initial drug monotherapy www.cbc.ca www.fims.uwo.ca

  9. Grim Statistics www.bbc.co.uk • 20% will show little or no response to multiple modes of aggressive treatment www.thelostboys.org www.cbc.ca www.fims.uwo.ca

  10. Reason for Optimism • Rapid advances in brain imaging and genetic mapping isolate specific brain networks and neural pathways implicated in mental illness uk.news.yahoo.com www.americanmonitoringphysicians.com http://brainatlas.org/aba/

  11. DBS Basics • DBS directly excites specific targets in the brain via electrodes on surgically-implanted leads • Electrical current interrupts “bad” brain impulses www.npr.org www.us.oup.com

  12. DBS Basics • Leads run to a generator implanted in the patient’s chest • A sort of “pacemaker for the brain” mac2.innanen.com www.henryfordhealth.org

  13. Dollars Well Spent? • $50,000 per patient per DBS procedure • Unknown amount of research dollars still needed to bring DBS to FDA approval stage • Are the effects costly enough to make funding DBS worthwhile? • Why not try more talk or drug therapies?

  14. Exacerbates or raises risk for… Cancer, diabetes, heart disease, obesity, et al. Substance abuse, suicide, death Cost of human suffering Treatment-Resistant Depression:Cost to Sufferer gallery.hd.org www.paigetropandweinstein.com www.nationalmssociety.org

  15. Treatment-Resistant DepressionCost to Families • Loss of companionship • Financial loss • Emotional & physical toll on primary caregiver(s) • Negative impact on next generation’s health and mortality rate www.who.int

  16. Treatment-Resistant Depression:Cost to Society • Directly related healthcare costs • $83 billion in 2002 • Healthcare costs linked through comorbid conditions • Diabetes patients with severe depression 86% higher healthcare expenses • Increased homelessness, substance abuse, morbidity http://www.sxc.hu/photo/524470

  17. Treatment-Resistant Depression:Costs to Economy • Decreased work productivity • Increased absenteeism • 27.2 lost workdays per ill worker per year • A leading cause of disability claims • Will be second only to cardiac disease by 2020 -- World Health Organization www.sxc.hu

  18. Criteria for DBS • DBS is exploratory and invasive • To be considered for DBS, a patient must meet certain criteria: • Major depression at least 5 years • Current episode at least 2 years • Ability to comply with monthly visits, prolonged testing visits, etc. www.becomehealthynow.com

  19. More Criteria • At least four failed antidepressants in two different classes while augmenting with two other therapies • Failure or intolerance to ECT therapy www.sxc.hu www.freeimages.co.uk news.bbc.co.uk www.cbc.ca

  20. DBS Surgery Steps taken in performing DBS surgery for depression are similar to those for Parkinson’s disease http://mac2.innanen.com/~bill/parkinsons/DBSsurgery/

  21. Bill’s DBS Step-by-Step • Bill is a Parkinson’s disease patient effectively treated with DBS • Here are the basic steps completed in order to implant Bill’s DBS electrical implants Warning: what follows is an honest portrayal of brain surgery and is not recommended for the faint of stomach. http://mac2.innanen.com/~bill/

  22. First, to the MRI mac2.innanen.com mac2.innanen.com mediabyran.kib.ki.se

  23. Head Is Secured • Head is secured in a stereotaxic frame “They assembled the stereotaxic frame from a kit that looked like a very expensive erector set.” --Bill mac2.innanen.com

  24. Awake but No Pain • Lidocaine for the skin and a lack of sensory nerves in the brain means pain-free surgery (except, of course, for the shot itself) “I was approached with a hypodermic that looked to me to be the size of a caulking gun.” --Bill mac2.innanen.com

  25. On the OR Table • Stereotaxic frame is bolted to operating room table for absolute stability • Another MRI is taken with Bill’s head firmly in place “Since the surgery is all done relative to the frame, this is a vitally important step.”--Bill mac2.innanen.com

  26. Going In • After the incision, a hole about the size of a dime (3/4 inch or 18 mm) is cut through the skull “Dr. Schlosser made the first incision at 8:29 AM. I didn't feel a thing except a little pressure. --Bill . mac2.innanen.com

  27. Probe Is Inserted • The micro drive advances a microelectrode probe down a hollow tube called “the introducer” • Once proper placement is achieved, the probe is removed and the final stimulator lead is eased through the introducer mac2.innanen.com

  28. On the OR Table • A stack of “listening” equipment stands ready and waiting for Bill’s brain waves • As the microelectrode is advanced, the signals it returns are monitored by listening to the speaker and watching the oscillograph “When the signal changed for a particular movement it would be noted on ‘the map’ … it was most important when the signal was clearly associated with my tremor.”--Bill . mac2.innanen.com

  29. Precise Location • The goal is to locate the probe in the precise locations needed to stop malfunctioning brainwaves • Once the location is found, leads are eased into place cms.clevelandclinic.org

  30. Stimulator Programming • Once Bill has healed from surgery, his stimulator is turned on and adjusted http://mac2.innanen.com/~bill/parkinsons/DBSsurgery/index.php?p=21 http://mac2.innanen.com/~bill/parkinsons/DBSsurgery/index.php?p=22

  31. Results of DBS for Depression • Dr. Helen Mayberg, et al., 2005 • Treated six TRD patients • Remember, all previous treatments failed • Four out of the six experienced near immediate relief • Within 6 months of treatment, near remission

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