Epidural Cortical Stimulation for Depression (EpCS-D)

The recruitment status of this study is unknown because the information has not been verified recently.
Verified July 2009 by Medical University of South Carolina.
Recruitment status was  Active, not recruiting
Sponsor:
Collaborators:
Medtronic
National Alliance for Research on Schizophrenia and Depression
Information provided by:
Medical University of South Carolina
ClinicalTrials.gov Identifier:
NCT00565617
First received: November 29, 2007
Last updated: July 6, 2009
Last verified: July 2009
  Purpose

Objective: Chronic epidural cortical stimulation (ECS) involves the neurosurgical placement of an electric wire on the surface of the brain with intermittent activation. Over time, ECS modulates local and distal connected brain regions. It is being currently applied over the motor cortex to treat intractable pain. Because of the important role played by the medial prefrontal cortex in mood regulation, the goal of this study is to apply this minimally invasive neurostimulation modality over medial prefrontal cortex in severely ill depressed subjects who have failed all other attempts at treatment.


Condition Intervention Phase
Treatment Resistant Depression
Device: Electroconvulsive therapy (ECT)
Device: Synergy, Epidural cortical stimulation
Phase 3

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: A Pilot Safety and Efficacy Study of Epidural Prefrontal Cortical Stimulation (EpCS) in Severe Treatment Resistant Depression

Resource links provided by NLM:


Further study details as provided by Medical University of South Carolina:

Primary Outcome Measures:
  • HDRS-24 items [ Time Frame: 5 months from baseline ] [ Designated as safety issue: No ]

Estimated Enrollment: 5
Study Start Date: October 2007
Estimated Study Completion Date: December 2009
Estimated Primary Completion Date: December 2009 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: 1
Epidural cortical stimulation (medial prefrontal cortex)
Device: Synergy, Epidural cortical stimulation
Epidural cortical stimulation
Other Name: Epidural cortical stimulation
Active Comparator: 2
Naturalistic follow up of outpatient ECT maintenance
Device: Electroconvulsive therapy (ECT)
Naturalistic follow up of ECT outpatient maintenance therapy with/without psychotropic medications

Detailed Description:

Hypothesis: Severely Treatment Resistant Unipolar Depressed Subjects with EpCS of medial prefrontal cortex will show a significant decrease in depression symptoms at 6 months post-implant when compared to baseline and to a matched control group treated with electroconvulsive therapy (ECT).

Method: We will enroll 5 subjects with severe refractory depression in an open trial with a 1 month placebo lead in, and for up to 1 years. We will also naturalistically follow 5 matched control patients treated with ECT. Depressive and cognitive symptoms will be rated periodically to assess the safety and efficacy of this procedure.

Significance: This study takes advantage of the expertise at MUSC with various neuromodulation technologies to begin answering the crucial role of targeted cortical brain stimulation and its potential role in treatment resistant depression. This is a crucial pilot study that might lead to an entire new class of therapies for depression.

  Eligibility

Ages Eligible for Study:   21 Years to 80 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

To be eligible for this study, a subject must meet all the following inclusion and exclusion criteria:

  • Subject has a diagnosis of chronic (≥ two years) or recurrent (multiple prior episodes) depression and is currently experiencing a major depressive episode without psychotic features as defined by DSM IV criteria.
  • Subjects may have a diagnosis or unipolar or bipolar depressive episode.
  • Subject has not had an adequate response to 4 or more adequate antidepressant treatments in the current depressive episode according to the Antidepressant Treatment History Form (ATHF) (Sackeim et al 1997).
  • Subject must be between the ages of 21 and 80.
  • Baseline HDRS 24-item ≥ 20 (both visits 1 week apart)
  • Subject must be able to complete the evaluations needed for this study including the functional imaging scans.
  • Subject must have had a history of one successful course of ECT in the past.
  • Subject must provide written informed consent.
  • Subject is stable on all antidepressant medication for at least 4 weeks before the baseline visit or not be taking antidepressant medication prior to entering the study.
  • Subject must be able to remain on current medication schedule for the first 19 weeks of the study.
  • Subject is not on a medication known to increase the risk of cortical stimulation-induced seizures. These include theophylline, stimulant medications, bupropion, or supraphysiological doses of thyroid supplements.

Exclusion Criteria:

The presence of any of the following will exclude a subject from the study:

  • The EpCS would (in the investigator's judgment) pose an unacceptable surgical or medical risk for the patient (including, but not limited to: history of serious cardiac or pulmonary problems, stroke, significant brain malformation, progressive neurological disease, central nervous system disease or injury, history of seizure, previous neurosurgical procedure with suspected brain tissue scarring that would increase the risks for seizure or cervical fracture).
  • Subject received general anesthetic within the last 30 days prior to enrollment (not including ECT procedure).
  • Subject currently has another investigational device or cardiac pacemaker, implantable defibrillator, or other implantable stimulator
  • Subject on anticoagulant drugs, with low platelets counts or have PT or PTT abnormalities or other risk factors for intra-operative or post-operative bleeding
  • Subject is expected to require full body magnetic resonance imaging (MRI) during the clinical study.
  • Subject is judged by the investigator to be acutely suicidal (e.g. within the 30 days prior to the EpCS implant, the subject has made a suicide attempt or gesture or has made specific plans or preparation to commit suicide).
  • Subject has a history of schizophrenia, schizoaffective disorder, or other psychotic disorder, active substance abuse or dependence (with the exception to caffeine and nicotine abuse) or a current major depressive episode that includes psychotic features (commonly referred to as psychotic depression) according to the DSM IV criteria.
  • Subject with a diagnosis of dementia with a Mini-Mental State Exam (MMSE) ≤23.
  • Female subjects with a positive urine pregnancy test.
  • Subject with a positive urine drug screen or current alcohol or substance abuse other than nicotine and caffeine.
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT00565617

Locations
United States, South Carolina
Medical University of South Carolina
Charleston, South Carolina, United States, 29403
Sponsors and Collaborators
Medical University of South Carolina
Medtronic
National Alliance for Research on Schizophrenia and Depression
Investigators
Principal Investigator: Ziad Nahas, MD, MSCR Medical University of South Carolina
  More Information

Additional Information:
NARSAD  This link exits the ClinicalTrials.gov site

No publications provided

Responsible Party: Ziad Nahas, MD, MUSC
ClinicalTrials.gov Identifier: NCT00565617     History of Changes
Other Study ID Numbers: HR - 16908
Study First Received: November 29, 2007
Last Updated: July 6, 2009
Health Authority: United States: Food and Drug Administration

Keywords provided by Medical University of South Carolina:
depression
epidural
cortical stimulation
brain stimulation
treatment-resistant
deep brain stimulation
TMS
DBS
ECS

Additional relevant MeSH terms:
Depression
Depressive Disorder
Behavioral Symptoms
Mood Disorders
Mental Disorders

ClinicalTrials.gov processed this record on April 14, 2014