Deep brain stimulation for obsessive-compulsive disorder and treatment-resistant depression: systematic review

<p>Abstract</p> <p>Background</p> <p>In spite of advances in psychotherapy and pharmacotherapy, there are still a significant number of patients with depression and obsessive-compulsive disorder that are not aided by either intervention. Although still in the experimental stage, deep brain stimulation (DBS) offers many advantages over other physically-invasive procedures as a treatment for these psychiatric disorders. The purpose of this study is to systematically review reports on clinical trials of DBS for obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD). Locations for stimulation, success rates and effects of the stimulation on brain metabolism are noted when available. The first observation of the effects of DBS on OCD and TRD came in the course of using DBS to treat movement disorders. Reports of changes in OCD and depression during such studies are reviewed with particular attention to electrode locations and associated adverse events; although these reports were adventitious observations rather than planned. Subsequent studies have been guided by more precise theories of structures involved in DBS and OICD. This study suggests stimulation sites and prognostic indicators for DBS. We also briefly review tractography, a relatively new procedure that holds great promise for the further development of DBS.</p> <p>Methods</p> <p>Articles were retrieved from MEDLINE via PubMed. Relevant references in retrieved articles were followed up. We included all articles reporting on studies of patients selected for having OCD or TRD. Adequacy of the selected studies was evaluated by the Jadad scale. Evaluation criteria included: number of patients, use of recognized psychiatric rating scales, and use of brain blood flow measurements. Success rates classified as "improved" or "recovered" were recorded. Studies of DBS for movement disorders were included if they reported coincidental relief of depression or reduction in OCD. Most of the studies involved small numbers of subjects so individual studies were reviewed.</p> <p>Results</p> <p>While the number of cases was small, these were extremely treatment-resistant patients. While not everyone responded, about half the patients did show dramatic improvement. Associated adverse events were generally trivial in younger psychiatric patients but often severe in older movement disorder patients. The procedures differed from study to study, and the numbers of patients was usually too small to do meaningful statistics or make valid inferences as to who will respond to treatment.</p> <p>Conclusions</p> <p>DBS is considered a promising technique for OCD and TRD. Outstanding questions about patient selection and electrode placement can probably be resolved by (a) larger studies, (b) genetic studies and (c) imaging studies (MRI, fMRI, PET, and tractography).</p

The Third Workshop on Population of the RDBES Data Model (WKRDB-POP3)

The aims of this workshop were to explain the data model developed for the commercial fisheries Regional Database and Estimation System (RDBES), assist in populating it with real data for the second test data call for the RDBES, and encourage participants to take part in ongoing testing of the RDBES data submission system. This report documents the progress that participants have done to prepare their institutes for future use of the RDBES system. Some issues with data conversion have been identified and are documented in this report. None of the identified issues are thought to be serious impediments to moving forward with the RDBES development according to the roadmap decided by the Steering Committee of the Regional Fisheries Database in 2020. The RDBES Core Group (the group of people developing the RDBES data model) and ICES Data Centre will look at the results of this workshop and either respond to individual questions or adapt the data model and documentation as required. The workshop concluded and reported before the deadline of the test data call. For a complete test of the data model, all participants were encouraged to complete the data call. A report on the degree of completion of the data call may be expected from WGRDBESGOV which convenes after the data call deadline

Compensating control participants when the intervention is of significant value: experience in Guatemala, India, Peru and Rwanda

The Household Air Pollution Intervention Network (HAPIN) trial is a randomised controlled trial in Guatemala, India, Peru and Rwanda to assess the health impact of a clean cooking intervention in households using solid biomass for cooking. The HAPIN intervention—a liquefied petroleum gas (LPG) stove and 18-month supply of LPG—has significant value in these communities, irrespective of potential health benefits. For control households, it was necessary to develop a compensation strategy that would be comparable across four settings and would address concerns about differential loss to follow-up, fairness and potential effects on household economics. Each site developed slightly different, contextually appropriate compensation packages by combining a set of uniform principles with local community input. In Guatemala, control compensation consists of coupons equivalent to the LPG stove’s value that can be redeemed for the participant’s choice of household items, which could include an LPG stove. In Peru, control households receive several small items during the trial, plus the intervention stove and 1 month of fuel at the trial’s conclusion. Rwandan participants are given small items during the trial and a choice of a solar kit, LPG stove and four fuel refills, or cash equivalent at the end. India is the only setting in which control participants receive the intervention (LPG stove and 18 months of fuel) at the trial’s end while also being compensated for their time during the trial, in accordance with local ethics committee requirements. The approaches presented here could inform compensation strategy development in future multi-country trials

Rostral cingulate gyrus: A putative target for deep brain stimulation in treatment-refractory depression

Surgery for intractable affective illnesses has generated considerable controversy over the last century. Deep brain stimulation (DBS) has revolutionized neurosurgical practice, especially in the field of advanced Parkinson’s disease and, more recently, in selected medical-refractory cases of obsessive-compulsive disorder. In this paper, we propose a discrete area of the rostral. cingulate gyrus as a potential target for DBS in medical-resistant depressive patients. Brodmann’s area 24a has proved to be a vital link in the integration of neural circuits underlying depression, both through proposed neurobiological models and accurate neuroimaging studies. The full reversibility and adjustability of DBS offer the best chance to treat the multidimensional and Life-span profile of depression, so giving hope to a great number of desperate human beings. (c) 2005 Elsevier Ltd. ALL rights reserved

Hydrocephalus according to Byzantine writers

OBJECTIVE: To describe hydrocephalus, the techniques applied for its treatment by Byzantine physicians, and their later influence. METHODS: A study and analysis of the original texts of the Byzantine medical writers, written in Greek, was undertaken. A comparison with current concepts also was made. RESULTS: Three eminent Byzantine physicians: Oribasius (4th century AD), Aetius (6th century AD), and Paul of Aegina (7th century AD) gave the first detailed information regarding hydrocephalus and its conservative and surgical treatment. These physicians, who were trained in Alexandria, quote the concepts of the now-lost works of the celebrated surgeons of the Pneumatic School of Alexandria Leonids and Heliodorus (1st century AD) and its follower Antyllus (2nd century AD). In the types of hydrocephalus they described, we identify the conditions currently known as cephalhematoma and subgaleal hematoma, for which conservative and surgical treatments were provided, and epidural hematoma, which was thought to be incurable. CONCLUSIONS: The term hydrocephalus was coined during the Hellenistic period. The clinical picture of the disease, however, as described by later Byzantine physicians, does not correspond to current concepts. The ideas of the Byzantine physicians were based on the ancient Hippocratic, Hellenistic, and Roman traditions, which influenced Arab medicine and then Western European medicine, thus constituting significant roots of modern neurosurgery

Functional outcome of intrathecal baclofen administration for severe spasticity

Purpose: To estimate the functional benefit in patients with severe spasticity treated with intrathecal baclofen infusion through an implantable pump and to stress the need for functional assessment of these patients with a functional scale. Patients and Methods: Between 1999 and 2003, 22 patients with a long history of severe and disabling pharmaceutically intractable spasticity, underwent implantation of a pump for continuous intrathecal baclofen infusion. The patients were subdivided into two categories according to the aetiology of spasticity: 15 had Multiple Sclerosis and seven had suffered a Spinal Cord Injury at different levels (from C4 to T11). Clinical status was assessed with the Ashworth and Penn spasm scales. Functional benefits were evaluated with the Barthel index score and pain relief with a self-reported visual analogue pain scale. Results: Postoperatively, all patients presented improvement in spasticity, reduction of spasm frequency, significant improvement in functional status, enhancement of life comfort and reduction of pain. Conclusion: Reduction of spasticity and spasms achieved with intrathecally delivered baclofen, leads to functional improvement and pain relief. (c) 2004 Elsevier B.V. All rights reserved