PMID: 21103178
AUTHORS: John P O'Reardon, Pilar Cristancho, Andrew D Peshek
REFERENCE: Psychiatry (Edgmont) 2006 May 3(5):54-63
Neuromodulation appears to be emerging gradually as a new therapeutic
field in psychiatric treatment. It encompasses neuropsychiatric medical
devices, such as vagus nerve stimulation (VNS), transcranial magnetic
stimulation (TMS), deep brain stimulation (DBS), and electroconvulsive
therapy (ECT). As a therapeutic approach to affective disorders,
neuromodulation shifts the focus from the monoamine synapse to neural
circuitry of the brain, which is dysregulated in depression. This neural
circuitry has been elaborated on over the course of 15 years of
neuroimaging research in mood disorders and is now believed to encompass
disturbances in a frontolimbic network. These include reduced
metabolism and blood flow in the prefrontal cortex and anterior
cingulate and pathologically increased activity in the subgenual
cingulate and amygdala.VNS is an implanted device that has established
efficacy in pharmaco-resistant epilepsy. It was approved by the FDA for
the treatment of severe, recurrent unipolar and bipolar depression in
July of 2005. VNS adopts a bottom-up approach to modulating the neural
circuitry of depression by stimulating vagal afferent fibers in the neck
, which carry impulses to the brain stem to target there the locus
ceruleus and dorsal raphe nucleus. Now that VNS has moved beyond the
experimental phase and into the clinic, psychiatrists are faced with
deciding who is an appropriate patient for this surgical implant and how
to integrate VNS into existing treatment in order to optimize both
efficacy and safety.This review of VNS will assess the efficacy and
safety data that led to the FDA approval. We will also review for the
busy clinician how VNS is likely to translate into clinical practice as
a treatment option for patients in need who are suffering from severe
depression.
Showing posts with label VNS. Show all posts
Showing posts with label VNS. Show all posts
Jun 16, 2009
Brain Stimulation in Depression Blog
There is an interesting weblog of Douglas Mental Health University Institute @ McGill which is certainly interesting for the readers of this Blog. Here is the description:
You can connect here or in the linklist to the left.Marcelo T. Berlim, MD, MSc, a researcher and clinical psychiatrist at the Douglas, presents the latest scientific information regarding the use of brain stimulation techniques in major depression, such as repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS), transcranial direct current stimulation (tDCS), and vagus nerve stimulation (VNS).
This blog is a resource for mental health professionals, including researchers and is not intended to provide medical consultation/referral and/or personal clinical advices.
Oct 3, 2008
Cyberonics Hasn't Found Depression-Business Partner
Normally I do not read business pages - but this is interesting for our scientific field. CNNMoney.com writes on the business outlook of Cyberonics for the depression indication. Overall the future does not seem too bright right now:
The need for a trial, plus the need to convince insurers, suggests it could take years before the depression business has a chance to speed up, said analyst Brozak, who has a sell rating on Cyberonics. In today's financial markets, that is a long and uncertain investment horizon for potential partners, he said.
Aug 15, 2008
Vagus nerve stimulation a treatment option, but not for everyone
MayoClinic.com published a short summary on the current state of Vagus Nerve Stimulation (VNS) intended for patient information. Other interesting links on Neurostimulation from their site are:
Jul 10, 2008
Electromagnetic Treatments for Depression Seek to Improve on ECT
medpage TODAY publised a nice summary of neuromodulatory approaches for depression. The following topics are discussed:- Vagus nerve stimulation
- Magnetic seizure therapy
- Repetitive transcranial magnetic stimulation
- Deep brain stimulation
- Transcranial direct current stimulation
- Implantable cortical stimulation
The new(er) kid on the block is obviously Implantable cortical stimulation, the author writes about this technique:
Another early-stage investigational technology takes vagus nerve stimulation a step farther. Instead of delivering electrical pulses to a nerve, it sends them to the surface of the brain. Seattle-based Northstar Neurosciences is testing a system that, like vagus nerve stimulation, inserts a pulse generator in the patient's chest. An electrical lead is passed into the skull through a surgically drilled hole, terminating on the dural membrane over the cortex.
Apr 16, 2008
Mood Disorders: Where Technology Meets Tradition
Annual Meeting & Scientific Program of the Ohio Psychiatric Physicians Association (OPPA
The meeting was held at the Hilton Cleveland East (Beachwood.) It was a well attending event with members from all over Ohio. It was exciting to see such a great resident turnout!
Here is a list of the great presentations we had this year:
"Neuroimaging and Psychiatry: Basic Principles and Possibilities" & "Neuroimaging and Neurocognitive Studies of Bipolar Disorder" by Jair C. Soares, MD
"Treatment Refractory Depression" by Stephen F. Pariser, MD
"Treatment Resistant Bipolar Disorder" by Prashant Gajwani, MD
"PET Imaging to Assess Acute and Chronic Effects of Vagus Nerve Stimulation on Treatment Resistant Depression" by Charles R. Conway, MD
"The Use of Deep Brain Stimulation in Psychiatric Disorders" by George E. Tesar, MD
"ECT for Treatment Resistant Mood Disorders" by Susan Kimmel, MD
Saturday, April 12th was the 2008 Spring/Annual Meeting for the OPPA: Mood Disorders: Where Technology Meets Tradition.
Here is a list of the great presentations we had this year:
"Neuroimaging and Psychiatry: Basic Principles and Possibilities" & "Neuroimaging and Neurocognitive Studies of Bipolar Disorder" by Jair C. Soares, MD
"Treatment Refractory Depression" by Stephen F. Pariser, MD
"Treatment Resistant Bipolar Disorder" by Prashant Gajwani, MD
"PET Imaging to Assess Acute and Chronic Effects of Vagus Nerve Stimulation on Treatment Resistant Depression" by Charles R. Conway, MD
"The Use of Deep Brain Stimulation in Psychiatric Disorders" by George E. Tesar, MD
"ECT for Treatment Resistant Mood Disorders" by Susan Kimmel, MD
Feb 14, 2008
Vagus Nerve Stimulation - Summary of Published Research
David Christmas from the Advanced Interventions Service of the National Services Scotland has put together an excellent Summary on VNS in Depression Research. You can access it here.
Feb 6, 2008
Vagus nerve stimulation for depression: efficacy and safety in a European study
Vagus nerve stimulation for depression: efficacy and safety in a European study.
BACKGROUND: Vagus nerve stimulation (VNS) therapy is associated with a decrease in seizure frequency in partial-onset seizure patients. Initial trials suggest that it may be an effective treatment, with few side-effects, for intractable depression.
METHOD: An open, uncontrolled European multi-centre study (D03) of VNS therapy was conducted, in addition to stable pharmacotherapy, in 74 patients with treatment-resistant depression (TRD). Treatment remained unchanged for the first 3 months; in the subsequent 9 months, medications and VNS dosing parameters were altered as indicated clinically.
RESULTS: The baseline 28-item Hamilton Depression Rating Scale (HAMD-28) score averaged 34. After 3 months of VNS, response rates (50% reduction in baseline scores) reached 37% and remission rates (HAMD-28 score <10) 17%. Response rates increased to 53% after 1 year of VNS, and remission rates reached 33%. Response was defined as sustained if no relapse occurred during the first year of VNS after response onset; 44% of patients met these criteria. Median time to response was 9 months. Most frequent side-effects were voice alteration (63% at 3 months of stimulation) and coughing (23%).
CONCLUSIONS: VNS therapy was effective in reducing severity of depression; efficacy increased over time. Efficacy ratings were in the same range as those previously reported from a USA study using a similar protocol; at 12 months, reduction of symptom severity was significantly higher in the European sample. This might be explained by a small but significant difference in the baseline HAMD-28 score and the lower number of treatments in the current episode in the European study.
PMID: 18177525 [PubMed - as supplied by publisher]
PDF: here
Jan 25, 2008
Nov 14, 2007
Vagus Nerve Is Direct Link From Brain To Immune System, Says Researcher
It used to be dogma that the brain was shut away from the actions of the immune system, shielded from the outside forces of nature. But that’s not how it is at all. In fact, thanks to the scientific detective work of Kevin Tracey, MD, it turns out that the brain talks directly to the immune system, sending commands that control the body’s inflammatory response to infection and autoimmune diseases. Understanding the intimate relationship is leading to a novel way to treat diseases triggered by a dangerous inflammatory response.
Dr. Tracey, director and chief executive of The Feinstein Institute for Medical Research, will be giving the 2007 Stetten Lecture on Wednesday, Oct. 24, at the National Institutes of Health in Bethesda, MD. His talk – Physiology and Immunology of the Cholinergic Anti-inflammatory Pathway – will highlight the discoveries made in his laboratory and the clinical trials underway to test the theory that stimulation of the vagus nerve could block a rogue inflammatory response and treat a number of diseases, including life-threatening sepsis.
With this new understanding of the vagus nerve’s role in regulating inflammation, scientists believe that they can tap into the body’s natural healing defenses and calm the sepsis storm before it wipes out its victims. Each year, 750,000 people in the United States develop severe sepsis, and 215,000 will die no matter how hard doctors fight to save them. Sepsis is triggered by the body’s own overpowering immune response to a systemic infection, and hospitals are the battlegrounds for these potentially lethal conditions.
The vagus nerve is located in the brainstem and snakes down from the brain to the heart and on through to the abdomen. Dr. Tracey and others are now studying ways of altering the brain’s response or targeting the immune system itself as a way to control diseases.
Dr. Tracey is a neurosurgeon who came into research through the back door of the operating room. More than two decades ago, he was treating a young girl whose body had been accidentally scorched by boiling water and she was fighting for her life to overcome sepsis. She didn’t make it. Dr. Tracey headed into the laboratory to figure out why the body makes its own cells that can do fatal damage. Dr. Tracey discovered that the vagus nerve speaks directly to the immune system through a neurochemical called acetylcholine. And stimulating the vagus nerve sent commands to the immune system to stop pumping out toxic inflammatory markers. “This was so surprising to us,” said Dr. Tracey, who immediately saw the potential to use vagus stimulation as a way to shut off abnormal immune system responses. He calls this network “the inflammatory reflex.”
Research is now underway to see whether tweaking the brain’s acetylcholine system could be a natural way to control the inflammatory response. Inflammation is key to many diseases - from autoimmune conditions like Crohn’s disease and rheumatoid arthritis to Alzheimer’s, where scientists have identified a strong inflammatory component.
Dr. Tracey has presented his work to the Dalai Lama, who has shown a great interest in the neurosciences and the mind-body connection. He has also written a book called “Fatal Sequence,” about the double-edge sword of the immune system.
- North Shore-Long Island Jewish (LIJ) Health System
Dr. Tracey, director and chief executive of The Feinstein Institute for Medical Research, will be giving the 2007 Stetten Lecture on Wednesday, Oct. 24, at the National Institutes of Health in Bethesda, MD. His talk – Physiology and Immunology of the Cholinergic Anti-inflammatory Pathway – will highlight the discoveries made in his laboratory and the clinical trials underway to test the theory that stimulation of the vagus nerve could block a rogue inflammatory response and treat a number of diseases, including life-threatening sepsis.
With this new understanding of the vagus nerve’s role in regulating inflammation, scientists believe that they can tap into the body’s natural healing defenses and calm the sepsis storm before it wipes out its victims. Each year, 750,000 people in the United States develop severe sepsis, and 215,000 will die no matter how hard doctors fight to save them. Sepsis is triggered by the body’s own overpowering immune response to a systemic infection, and hospitals are the battlegrounds for these potentially lethal conditions.
The vagus nerve is located in the brainstem and snakes down from the brain to the heart and on through to the abdomen. Dr. Tracey and others are now studying ways of altering the brain’s response or targeting the immune system itself as a way to control diseases.
Dr. Tracey is a neurosurgeon who came into research through the back door of the operating room. More than two decades ago, he was treating a young girl whose body had been accidentally scorched by boiling water and she was fighting for her life to overcome sepsis. She didn’t make it. Dr. Tracey headed into the laboratory to figure out why the body makes its own cells that can do fatal damage. Dr. Tracey discovered that the vagus nerve speaks directly to the immune system through a neurochemical called acetylcholine. And stimulating the vagus nerve sent commands to the immune system to stop pumping out toxic inflammatory markers. “This was so surprising to us,” said Dr. Tracey, who immediately saw the potential to use vagus stimulation as a way to shut off abnormal immune system responses. He calls this network “the inflammatory reflex.”
Research is now underway to see whether tweaking the brain’s acetylcholine system could be a natural way to control the inflammatory response. Inflammation is key to many diseases - from autoimmune conditions like Crohn’s disease and rheumatoid arthritis to Alzheimer’s, where scientists have identified a strong inflammatory component.
Dr. Tracey has presented his work to the Dalai Lama, who has shown a great interest in the neurosciences and the mind-body connection. He has also written a book called “Fatal Sequence,” about the double-edge sword of the immune system.
- North Shore-Long Island Jewish (LIJ) Health System
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