BEST BRAIN STIMULATION TREATMENT FOR MENTAL ILLNESSES By Liam Phelan.

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


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


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

http://www.sciencedirect.com/science/article/pii/S089662730500156X#tblfn1



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

neuneu

QUESTIONS?QUESTIONS?

BEST BRAIN STIMULATION TREATMENT FOR MENTAL ILLNESSES By Liam Phelan.

Documents

Transcript of BEST BRAIN STIMULATION TREATMENT FOR MENTAL ILLNESSES By Liam Phelan.