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Depression: Individually tailored brain implants used for treatment

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Sara received a new brain stimulation treatment for depression

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Women with severe depression have been successful in using radical new treatments for a year, including placing electrodes deep in the brain. “Everything has become easier,” says 36-year-old Sarah, who first tried the new technology.

For now, this remedy can only be used in people with the most severe depression. This is because it includes two brain surgeries and the number of days to record electrical signals in the brain to calculate activity patterns, or “nerve biomarkers.” Symptoms of each individual.

“These results provide the hope that the long-awaited personalized biomarker-based treatment for mental illness is possible,” he said. Catherine Scangos At the University of California, San Francisco.

Importantly, the electrodes fire hundreds of times a day, only when necessary, each time a particular pattern of brain activity is detected.A simpler form of brain stimulation, with the device always on, is already used in movement disorders Parkinson’s disease, Where the relevant areas of the brain are relatively well understood. Such continuous brain stimulation, which was previously attempted in depression, Test results are mixedProbably because the responsible brain circuit is unknown.

When trying to help Sarah, the Scangoss team began by recording electrical activity from 10 different parts of her brain while she reported her mood over a 10-day period. Sarah has been experiencing depression since childhood, which was not helped by many different medications and electroconvulsive therapies. Prior to surgery, she experienced suicidal ideation several times an hour.

Research has shown that in the worst cases of Sarah’s symptoms, there was a characteristic pattern of activity known as gamma. Brain waves In her amygdala, two small structures deep in the brain that were previously associated with emotions.

Turning on the electrodes in another part of her brain, known as the right ventral capsule / ventral striatum (VC / VS), alleviated both gamma EEG and depression symptoms. “When I was first inspired, I felt the most intense sense of joy, and my depression was a distant nightmare for a moment,” says Sarah.

VC / VS were also thought to be already involved in depression. It has been targeted in several past trials of continuous brain stimulation, with a small number of people suffering from very severe depression removing the area by brain surgery. “In the context of what happened before, it makes a lot of sense,” he says. Ludwig Zulinzo At University College London Hospital performing such surgery.

The type of radiofrequency stimulation performed in the new study is thought to reduce brain activity by preventing nearby brain cells from firing normally and temporarily mimicking the effects of surgery. In the case of Sarah, the stimulation seems to reduce the right VC / VS and attenuate the gamma EEG in the right amygdala. Scans also showed that these two structures were highly connected in her brain.

After the initial investigation, the team implanted two connected permanent electrodes so that only one would fire if one detected a gamma wave in the amygdala. It operates about 300 times a day for 6 seconds, and the strength is set low, so Sarah does not notice it. “We don’t want this to disrupt her life,” says Scangos.

However, Sarah noticed that her mood improved overall when she turned on the device. “It’s a step-by-step process and my lens in the world has changed,” she says. “As time went on, this virtuous cycle went up. Everything became easier. My hobbies became fun again. A year after the treatment, this device kept my depression away. It was. “

Scangos plans to use the same approach with 11 more people.

The results are impressive, but he says this may not be useful to everyone. Keyoumars Ashkan At King’s College Hospital in London. “Everyone’s mood-related brain circuits can be slightly different.”

The first results from continuous brain stimulation techniques were also impressive, but in randomized trials Not enough people get better For a widely used approach.

This latest version of brain stimulation is also cost- and labor-intensive and requires several days of research and two surgeries. However, the same approach has already been used for people with epilepsy who need to make records in several brain regions to find out where the seizures begin before undergoing surgery to destroy defective tissue. There is precedent for such a method.

“With the time and effort of investigating an individual, this treatment can be highly personalized,” says Ashkan. “That’s exciting about this.”

Journal reference: Nature medicine, DOI: 10.1038 / s41591-021-01480-w

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Depression: Individually tailored brain implants used for treatment

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