Deep Brain Stimulation (DBS) for Depression Using Directional Current Steering and Individualized Network Targeting

• ClinicalTrials.gov Identifier: NCT03437928
• Recruitment Status: Recruiting
• First Posted: February 19, 2018
• Last Update Posted: November 12, 2020
• Sponsor: Baylor College of Medicine
• Collaborator: University of California, Los Angeles
• Information provided by (Responsible Party): Sameer Sheth, Baylor College of Medicine

Study Description

Brief Summary:

The goal of the study is to address the unmet need of TRD patients by identifying brain networks critical for treating depression and to use next generation precision DBS with steering capability to engage these targeted networks. The study's goal will be achieved through 3 specific aims:

1. Demonstrate device capability to selectively and predictably engage distinct brain networks
2. Delineate depression-relevant networks and demonstrate behavioral changes with network-targeted stimulation
3. Demonstrate that chronic DBS using steered, individualized targeting is feasible and safe for reducing depressive symptoms

Condition or disease	Intervention/treatment	Phase
Major Depressive Disorder	Device: Directional Deep Brain Stimulation	Not Applicable

Detailed Description:

Treatment-resistant depression (TRD) is a major worldwide burden. Major depression has a lifetime prevalence of ~15% across developed countries. Up to a third of patients fail to respond adequately to evidence-based treatments, including pharmacological, behavioral, and electroconvulsive therapy. The investigators employ an innovative approach, including subacute invasive neurophysiological monitoring with which they aim to gain insight into the networks underlying depression symptomatology, confirm the ability to predict the effects of precision DBS on network activity, and harmonize these insights to implement network-guided DBS for TRD.

Study Design

• Study Type: Interventional (Clinical Trial)
• Estimated Enrollment: 12 participants
• Allocation: N/A
• Intervention Model: Single Group Assignment
• Masking: None (Open Label)
• Primary Purpose: Treatment
• Official Title: Deep Brain Stimulation (DBS) for Depression Using Directional Current Steering and Individualized Network Targeting
• Actual Study Start Date: August 20, 2019
• Estimated Primary Completion Date: August 19, 2023
• Estimated Study Completion Date: August 19, 2024

Arms and Interventions

Arm	Intervention/treatment
Experimental: Directional Deep Brain Stimulation	Device: Directional Deep Brain Stimulation; Boston Scientific Vercise DBS leads and 16-channel implanted pulse generators (IPGs) will be implanted to control the shape and size of stimulation

Outcome Measures

Primary Outcome Measures :

1. Changes in depressive symptoms [ Time Frame: 54 to 60 months ]
   Response will be defined as 50% decrease in Montgomery-Asberg Depression Rating Scale (MADRS) from baseline. The range is from 0 to 60 and a score higher than 20 indicates moderate to severe depression.

Eligibility Criteria

• Ages Eligible for Study: 22 Years to 70 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

1. Men and women (non-pregnant) between ages 22 and 70;
2. DSM-5 diagnosis (assessed by Structured Clinical Interview for DSM-5 Axis I disorders SCID-5) of major depression disorder (MDD) as the primary diagnosis. A current major depressive episode (MDE), recurrent or single episode with first episode before age 60, secondary to nonpsychotic unipolar major depressive disorder;
3. Chronic illness with current MDE ≥24 months duration and/or recurrent illness with at least a total of 2 lifetime episodes (including current episode >12 months);
4. Treatment resistance (defined by criteria on the Antidepressant Treatment History Form ATHF): Failure (i.e. persistence of the major depressive episode) to respond to a minimum of four adequate depression treatments from at least two different treatment categories (e.g. SSRIs, SNRIs, TCAs, other antidepressants, lithium-addition, irreversible MAOIs, antidepressant augmentation with an atypical antipsychotic medication);
5. Previous trial of Electroconvulsive Therapy (ECT) (lifetime): either did not respond, relapsed, poorly tolerated or refused. If refused, will discuss reasons and ensure subject understands relative risks of ECT versus DBS. We will try to enrich sample with patients who had previously shown response to ECT (or another intervention) that was partial or un-sustained;
6. A prior trial of ketamine will not be required because it is not FDA approved and durable responses have not been demonstrated, nevertheless, subjects will be informed about this possible off-label option;
7. Symptom severity for Screening: Hamilton Depression Rating Scale-17 item (HDRS17) ≥20;
8. The HDRS17 must remain greater than or equal to 20 on two separate assessments (at initial screening and 1 week before surgery), over a 1-month period;
9. Symptom severity for Outcome: Montgomery Asberg Rating Scale (MADRS) ≥27 to be met at assessment one-week pre-op;
10. Lifetime exposure to minimal 6 weeks of psychotherapy without sustained response;
11. Normal brain MRI within 3 months of surgery;
12. Stable antidepressant medication regimen for the month preceding surgery;
13. Modified mini-mental state examination (MMSE) score ≥ 24;
14. Normal thyroid stimulating hormone (TSH) level within 12 months of study entry;
15. Other medical conditions must be stable for at least 6 months;
16. Able and willing to give informed consent and agree to attend regular clinic visits for at least 12 months following surgery;
17. Able to have a treating psychiatrist or close relative present for discussions about the study and co-sign informed consent;
18. Willingness to sign Treatment Contract

Exclusion Criteria:

1. DSM-5 Axis I Disorders: any lifetime history of psychotic disorder (e.g., schizophrenia, schizoaffective disorder);
2. Bipolar disorder with rapid cycling and history of manic episode requiring hospitalization within the past 5 years;
3. Clinically significant Cluster A or B personality disorder;
4. Active alcohol or substance use disorder within 6 months, excluding nicotine;
5. Urine drug test positive for illicit drugs;
6. Current substantial suicidal risk as defined by a plan or clear immediate intent for self-harm, or made a suicide attempt within the last year; or as identified as C-SSRS;
7. Neurological/Medical condition that makes the patient, in the opinion of the surgeon, a poor surgical candidate (e.g., progressive neurodegenerative disorder, significant cardiopulmonary disorder, need for chronic anticoagulation);
8. Any history of seizure disorder or hemorrhagic stroke;
9. Any medical contraindication to surgery such as infection;
10. Coagulopathy: Bleeding propensity and/or one of the following: INR > 1.5; prolonged activated partial thromboplastin time (aPTT) ≥ 45 sec; platelet count < 100×103/uL;
11. Uncontrolled hypertension (systolic > 185 mmHg and/or diastolic > 110 mmHg), demonstrated on each of three repeated measurements taken within one hour regardless of whether or not the patient is taking antihypertensive medications.
12. Participation in another drug, device, or biological trial within 90 days;
13. Current implanted stimulation devices including cardiac pacemakers, defibrillators, and neurostimulators including spinal cord stimulators and deep brain stimulators;
14. Pregnant or has plans to become pregnant in the next 24 months;
15. Anticipated need for MRI;
16. Need for Diathermy;
17. Chronic use of anticoagulant or anti-platelet agents that cannot be safely stopped for a sufficient duration (minimum 2.5 weeks) in the peri-operative period.

Contacts and Locations

Contacts

Contact: Sameer A Sheth, MD, PhD; 713-798-5060; sameer.sheth@bcm.edu

Locations

United States, California

University of California, Los Angeles; Recruiting

Los Angeles, California, United States, 90095

Contact: Dana Levin 310-267-4331 dlevin@mednet.ucla.edu

Contact: Nader Pouratian 310-825-5111 NPouratian@mednet.ucla.edu

United States, Texas

Baylor College of Medicine; Recruiting

Houston, Texas, United States, 77030

Contact: Victoria Pirtle 713-798-1717 victoria.pirtle@bcm.edu

Contact: Sameer A Sheth, MD, PhD 713-798-5060 sameer.sheth@bcm.edu

Principal Investigator: Sameer A Sheth, MD, PhD

Sponsors and Collaborators

Baylor College of Medicine

University of California, Los Angeles

Investigators

• Principal Investigator: Sameer A Sheth, MD, PhD; Baylor College of Medicine

More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Powell M, Anso J, Gilron R, Provenza N, Allawala A, Silva D, Bijanki K, Oswalt D, Adkinson J, Pouratian N, Sheth S, Goodman W, Jones S, Starr PA, Borton D. NeuroDAC: An open-source arbitrary biosignal waveform generator. J Neural Eng. 2020 Nov 5. doi: 10.1088/1741-2552/abc7f0. [Epub ahead of print]

• Responsible Party: Sameer Sheth, Associate Professor, Vice-Chair of Clinical Research, Department of Neurosurgery, Baylor College of Medicine
• ClinicalTrials.gov Identifier: NCT03437928
• Obsolete Identifiers: NCT03964194
• Other Study ID Numbers: H-43036
• First Posted: February 19, 2018
• Last Update Posted: November 12, 2020
• Last Verified: November 2020

Individual Participant Data (IPD) Sharing Statement:

• Plan to Share IPD: Yes
• Supporting Materials: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF); Clinical Study Report (CSR); Analytic Code

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: Yes

Keywords provided by Sameer Sheth, Baylor College of Medicine:

Major Depressive Disorder (MDD); MDD; Neuromodulation; Deep Brain Stimulation (DBS); DBS; Electrophysiology; Imaging

Additional relevant MeSH terms:

Depression; Depressive Disorder; Depressive Disorder, Major; Behavioral Symptoms; Mood Disorders; Mental Disorders