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ON/OFF Stimulation and Reward Motivation in Patients With Deep Brain Stimulators

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details. Identifier: NCT01590862
Recruitment Status : Recruiting
First Posted : May 3, 2012
Last Update Posted : March 6, 2019
Information provided by (Responsible Party):
Darin Dougherty, Massachusetts General Hospital

Brief Summary:
The primary aim of this study is to test the effects of excitation of ventral striatal circuitry via DBS (e.g. DBS-on versus DBS-off) on reward motivation. The investigators predict that stimulation will increase subject willingness to expend effort for rewards and facilitate motivation for reward learning. The investigators further predict that individual differences in the effects of DBS on reward motivation as will be associated with effects of DBS treatment on anhedonic symptoms.

Condition or disease
Obsessive Compulsive Disorder Major Depressive Disorder

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Detailed Description:

The study will take place at a clinical office in the Charlestown Navy Yard (CNY), and will consist of one 4 or 4.5-hour visit. Study staff will schedule a convenient time for patients to arrive, or the research visit may be paired with a regularly scheduled DBS programming visit. A member of the Division of Neurotherapeutics authorized to manipulate DBS programming will turn the device on and off during the study. The subject's therapeutic parameters of the DBS system will not be changed. The subject will be asked to complete four self-report questionnaires: the Temporal Experience of Pleasure questionnaire, the Chapman Anhedonia Questionnaire, the Perceived Stress Questionnaire (PSS) and the Mood and Anxiety Symptom Questionnaire (MASQ). Following these questionnaires, a member of the study staff will teach the subjects to perform the following tasks on the computer:

Effort Expenditure for Rewards Task (EEfRT) To measure motivation to work for rewards, we will use the Effort Expenditure for Rewards Task (EEfRT or "effort"). The EEfRT is a multi-trial computer-based task that assess an individual's willingness to expend effort for the chance to earn monetary rewards developed by Michael Treadway and David Zald at Vanderbilt University (Treadway et al., 2009). On each trial, subjects are given an opportunity to choose between two different task difficulty levels in order to obtain monetary rewards. For all trials, subjects must make repeated manual button presses in a set period of time. Each button press raises the level of a virtual "bar" viewed onscreen by the subject. Subjects will be eligible to win the money allotted for each trial if they are able to raise the bar to the "top" within the prescribed time period. This button-press task has two levels of difficulty: referred to henceforth as the 'hard task' or 'easy task'. Successful completion of hard task trials requires the subject to make 100 button presses, using the non-dominant pinky finger within 30 seconds, while successful completion of easy task trials requires the subject to make 30 button presses, using the dominant index finger within 10 seconds.

For easy task choices, subjects are eligible to win the same amount on each trial if they successfully complete the task. For hard task choices, subjects are eligible to win an amount that varies per trial. Subjects are not guaranteed to win the stated reward if they complete the task; some trials are 'win' trials, in which the subject receives the stated reward amount, while others are 'no win' trials, in which the subject receives no money for that trial. To help subjects determine which trials are more likely to be win trials, subjects are provided with probability cues at the beginning of each trial. Trials have three levels of probability: 88% probability of being a win trial, 50% and 12%. There are equal proportions of each probability level across the experiment. Each level of probability appears once in conjunction with each level of reward value for the hard task.

At the beginning of the task, subjects are provided with a detailed set of instructions, and an opportunity to play 4 practice trials. Subjects are then told that they will have twenty (20) minutes to play as many trials as they can. Easy Task choices take approximately 15 seconds, whereas Hard Task choices take approximately 30 seconds. Therefore, the number of trials that the subject is able to play will depend in part on the choices that she makes. This means that making more Hard Task trials early-on in the experiment will result in fewer trials total, which may mean that the subject does not get a chance to play high-value, high-probability trials that could appear towards the end of the playing time. This trade-off is explained clearly to the subject. The goal of this trade-off is to ensure that neither a strategy of always choosing the easy or the hard option can lead to optimal performance on the task. Moreover, the complexity of variables (with varying monetary reward levels, probability, and loss of time for future trials), does not lend itself to a formal calculation of an optimal response selection, forcing Subjects to make a relatively rapid decision, that we believe taps individual differences in the willingness to expend effort for a given level of expected reward value.

At the end of the task, two trials are randomly selected that will be added to the subject's compensation as a reward incentive. Subjects therefore may earn additional funds in incentive performance compensation each time they complete the EEfRT.

Clock Task The "clock task" is an additional reward task that assesses reward learning developed by Michael Frank and colleagues (Moustafa et al., 2008; Frank et al., 2009). For this task, participants observe a clock arm that completes a revolution over the course of 5 seconds, and participants are instructed to press a key to stop the clock at any time in an attempt to win points. The amount of points won varies depending on RT, and participants must use trial-and-error strategies to learn when to stop the clock so as to maximize points received. To prevent subjects form explicitly learning reward values associated with a specific location on the clock face, reward values at any given point along the clock face are randomized within +/- 5 points. At the end of the task, subjects may redeem points for a small amount of additional compensation, each time they complete the task. This task takes approximately 15 minutes to complete.

30 minutes after turning OFF DBS stimulation, participants will either remain in the OFF condition or will have the DBS turned ON, depending on their counter-balanced condition assignment. Subject assignment will alternate sequentially. Subjects will complete the tasks above in the first condition. Following task completion, subjects will have DBS stimulation turned OFF or ON (again, depending on condition assignment). After 30 minutes, participants will complete the same tasks in the second condition. Following retesting, participants that were in the OFF condition will return to ON DBS stimulation.

We will be using the implanted pulse generator, so it is not possible to deliver an unsafe current. Because we are not changing the therapeutic parameters of stimulation, subjects should not experience and adverse side effects. The computer will register the subject's performance.

Electroencephalography recordings (EEG) will be acquired during performance of the aforementioned tasks. Continuous EEG data will be sampled at a maximum of 1024Hz using a 64-electrode cap. Eye movement artifacts will be assessed using bipolar electrodes.

Patients with just major depressive disorder or obsessive compulsive disorder will also be recruited as a control group for the patients with deep brain stimulation.

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Study Type : Observational
Estimated Enrollment : 60 participants
Observational Model: Cohort
Time Perspective: Cross-Sectional
Official Title: ON/OFF Stimulation and Reward Motivation in Patients With Deep Brain Stimulators
Study Start Date : June 2012
Estimated Primary Completion Date : December 2020
Estimated Study Completion Date : December 2020

Resource links provided by the National Library of Medicine

Deep Brain Stimulation Effects on Reward Motivation
We will assess changes in Reward Motivation behavior with Deep Brain Stimulation on and off.
Patients with MDD or OCD
Patients with MDD or OCD who do not have a deep brain stimulator.

Primary Outcome Measures :
  1. Effort Expenditure for Rewards Task (EEfRT) [ Time Frame: 2 hours ]
    The EEfRT is a multi-trial computer-based task that assess an individual's willingness to expend effort for the chance to earn monetary rewards. We will assess whether stimulation of the Ventral Capsule/Ventral Striatum has an effect on behavior by executing this task with the DBS system on and off.

Secondary Outcome Measures :
  1. Reward learning (clock task) [ Time Frame: 2 hours ]
    This task is an additional reward task that assesses reward learning. We will assess whether stimulation of the Ventral Capsule/Ventral Striatum has an effect on behavior by executing this task with the DBS system on and off.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years to 70 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Patients with Deep Brain Stimulation AND Patients with Major Depressive Disorder or Obsessive-Compulsive Disorder and no DBS

DBS Patients:

Inclusion Criteria:

  • Deep brain stimulator implantation performed at least three months prior to study

Exclusion Criteria:

  • Subjects unable to visualize stimulus objects with correction
  • Dementia or other known cognitive deficit

Psychiatric Patients:

Inclusion Criteria:

  • Right-handed (as determined by the Handedness Inventory; Oldfield, 1971)
  • Normal or corrected-to normal vision and hearing
  • Current diagnosis of MDD or OCD

Exclusion Criteria for Patients:

  • Clinical history of bipolar disorder
  • Current or past psychotic disorder
  • Gross structural brain damage
  • Cognitive impairment that would affect a participant's ability to give informed consent
  • Current substance abuse, or abuse within the past 3 months
  • Clinical history of severe personality disorder
  • Imminent risk of suicide or an inability to control suicide attempts
  • Evidence of dementia or other significant cognitive impairment on neuropsychological evaluation

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01590862

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Contact: Aishwarya Gosai, BA 617-724-0244

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United States, Massachusetts
Massachusetts General Hospital Recruiting
Boston, Massachusetts, United States, 02114
Contact: Darin D Dougherty, MD   
Principal Investigator: Darin D Dougherty, MD         
Massachusetts General Hospital Not yet recruiting
Charlestown, Massachusetts, United States, 02129
Contact: Anna L Gilmour, BA    617-726-9281   
Principal Investigator: Darin D Daugherty, MD         
Sponsors and Collaborators
Massachusetts General Hospital

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Responsible Party: Darin Dougherty, Associate Professor of Psychiatry, Massachusetts General Hospital Identifier: NCT01590862     History of Changes
Other Study ID Numbers: 2011P002821
First Posted: May 3, 2012    Key Record Dates
Last Update Posted: March 6, 2019
Last Verified: March 2019
Keywords provided by Darin Dougherty, Massachusetts General Hospital:
Obesessive Compulsive Disorder
Major Depressive Disorder
Deep Brain Stimulation
Additional relevant MeSH terms:
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Depressive Disorder
Depressive Disorder, Major
Compulsive Personality Disorder
Obsessive-Compulsive Disorder
Pathologic Processes
Mood Disorders
Mental Disorders
Behavioral Symptoms
Personality Disorders
Anxiety Disorders