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PCS in Severe Treatment Resistant Depression

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ClinicalTrials.gov Identifier: NCT04124341
Recruitment Status : Recruiting
First Posted : October 11, 2019
Last Update Posted : September 21, 2022
Information provided by (Responsible Party):
University of Minnesota

Brief Summary:

This research study is designed to test if electrical stimulation of the surface of the brain in the frontal region will help treat depressive symptoms. Participants receive intermittent electrical stimulation to the brain, which involves surgically placing electric leads in between the tough fibrous membrane covering the surface of the brain and the surface of the brain itself. This type of stimulation is referred to as bilateral subdural prefrontal cortical stimulation (PCS) because it will specifically target the outer layer of the brain at the midline, right behind the forehead. It uses a pacemaker-like device, the Proclaim Elite SCS System (Abbott Laboratories) for stimulation.

Although the U.S. Food and Drug Administration (FDA) has approved the system for brain stimulation for patients with chronic pain and muscular diseases, such as Parkinson's, its use is still investigational, and the surgery is still experimental for patients who have depression.

Condition or disease Intervention/treatment Phase
Treatment Resistant Depression Device: Prefrontal Cortical Stimulation (PCS) Not Applicable

Detailed Description:

This study has four distinct stages.

Stage 1: Baseline Assessments There is a 14-day baseline period to determine eligibility, including medical history, physical and neurological examinations, and medical test including EKG, blood work, pregnancy test, depression assessments and cognitive assessments. An MRI will also be done prior to implant in order to help the surgeon determine where best to place the leads.

Stage 2: Surgery If deemed to be medically eligible, participants will be hospitalized for a minimum of 3 days, during which they will undergo surgery to implant the device and leads. There will be testing of the leads to explore optimal testing parameters. According to the surgeon's judgment, participants may or may not receive stimulation for 3 weeks following surgery.

Stage 3: Acute phase (19 weeks) Following implantation, participants undergo a CT scan to ensure proper implantation. Later, participants complete 10 follow up visits where assessments of symptoms will be made. Additionally, the first visit will consist of the investigator programming the stimulator while participants watch various photographs with different emotional content and have their brain electrical activity recorded. This will help the investigator choose the best settings for treatment. Pregnancy tests will be done as appropriate, and blood will be drawn at two visits.

Stage 4: Long term follow up (7 months) All participants who complete stage 3 will be offered continued treatment. Participants complete 7 monthly follow-up visits where assessments of symptoms are made. Pregnancy tests will be done as appropriate, and blood will be drawn at each visit.

Objectives (confirm target engagement and demonstrate clinical relevance):

To assess the impact of PCS on Late Positive Potential (LPP), which reliably captures biased attention and early affective responses to environmental stimuli.

To examine the relationship between changes in LPP and clinical improvement.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 15 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Prefrontal Cortical Stimulation (PCS) for Severe Treatment Resistant Depression
Actual Study Start Date : September 29, 2021
Estimated Primary Completion Date : December 31, 2023
Estimated Study Completion Date : December 31, 2023

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: Prefrontal Cortical Stimulation (PCS)
Stereotactically implanted bilateral PCS
Device: Prefrontal Cortical Stimulation (PCS)
Prior to surgery, subjects will undergo a high resolution structural scan to identify anatomical landmarks for rostral anterior and lateral prefrontal cortex. Following identification of target areas, PCS quad leads will be projected over the anterior and lateral prefrontal cortex. Subjects will be kept in the hospital for a minimum of 72 hours for observation during which the investigators will obtain a high resolution spiral CT scan without contrast to confirm lead placements post-operatively and rule out any intra-cranial bleeds. Patients will receive analgesics which they may continue as an outpatient on as needed basis. During this 2-3 weeks recovery period, the attention to pain control and mood is critical. The research team will contact patients at least twice per week to check on their status.

Primary Outcome Measures :
  1. Change in LPP Amplitude [ Time Frame: 6 months ]
    Change in late positive potential (LPP) amplitude as a result of Bayesian optimized bilateral PCS. LPP is an event-related potential (ERP) measured by electroencephalography (EEG), which reliably captures biased attention and early affective responses to environmental stimuli.

Secondary Outcome Measures :
  1. Change in HRSD Scores [ Time Frame: 6 months ]
    In order to demonstrate that sustained lowering of LPP as a result of Bayesian optimized bilateral PCS, impacts depressive symptoms, change in Hamilton Rating Scale for Depression (HRSD) scores will be calculated.

Information from the National Library of Medicine

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Ages Eligible for Study:   22 Years to 55 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Participant has a diagnosis of chronic (greater than or equal to 2 years) depressive episode as defined by DSM V criteria
  • Participant has not had an adequate response to three or more adequate antidepressant treatments from at least two different antidepressant treatment categories in the current depressive episode according to the Antidepressant Treatment History Form (ATHF)
  • Participant must have had ECT or refused to undergo ECT if clinically indicated to them
  • Participant must have HRSD greater than or equal to 20
  • Participant must be able to complete the evaluations needed for this study including the functional imaging scans and the EEG Bayesian optimization sessions
  • Participant must be under the care of a licensed psychiatrist, undergoing regular care evaluations, and inform study team of any change to care team during study participation
  • Participant must agree to allow all forms of communication between investigators and study staff and any health care provider (current or having provided service within two years of enrollment)
  • Participant must provide name and contact information for at least two people greater than or equal to 22 in age who reside within a 30 minute drive of the participant's residents and whom staff may contact as necessary during study participation
  • Participant must be enrolled in a Medicare program

Exclusion Criteria:

  • The EpCS would (in the investigator's judgment) pose an unacceptable surgical or medical risk for the participant
  • Participant is expected to require full body magnetic resonance imaging (MRI) during the clinical study
  • Participant is judged by the investigator to be acutely suicidal (e.g. within the 30 days prior to the EpCS implant the participant has made a suicide attempt or gesture or has made specific plans or preparation to commit suicide or scores 14 or higher on the SSI)
  • In addition to the acute suicidal risks mentioned above, participant meets any of the following:

    1. Has made a suicide attempt within the previous 12 months that required medical treatment
    2. Has made greater than or equal to two suicide attempts in the past 12 months
    3. Has a clear-cut plan for suicide that states that she/he cannot guarantee that she/he will call her/his regular psychiatrist or the Investigator if the impulse to implement the plan becomes substantial during the study
    4. Is likely to attempt suicide within the next six months, in the Investigator's opinion
  • Participant has a history of schizophrenia, schizoaffective disorder, or other psychotic disorder, or a current major depressive episode that includes psychotic features (commonly referred to as psychotic depression) according to the DSM V criteria
  • Participant with a diagnosis of dementia with a Mini-Mental State Exam (MMSE) less than or equal to 23
  • Participant with a positive urine pregnancy test
  • Participant with a positive urine drug screen
  • Participant with DBS
  • Participant with VNS if the device was active in the last 6 months prior to study enrollment
  • Participant with history of seizures

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 ClinicalTrials.gov identifier (NCT number): NCT04124341

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Contact: Ziad Nahas, MD, MSCR 612-273-9732 znahas@umn.edu
Contact: Rachel Johnson 952-525-4505 ipl@umn.edu

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United States, Minnesota
University of Minnesota Recruiting
Minneapolis, Minnesota, United States, 55455
Contact: Ziad Nahas, MD, MSCR         
Sponsors and Collaborators
University of Minnesota
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Principal Investigator: Ziad Nahas, MD University of Minnesota
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Responsible Party: University of Minnesota
ClinicalTrials.gov Identifier: NCT04124341    
Other Study ID Numbers: PSYCH-2019-27331
First Posted: October 11, 2019    Key Record Dates
Last Update Posted: September 21, 2022
Last Verified: September 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Additional relevant MeSH terms:
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Depressive Disorder
Depressive Disorder, Treatment-Resistant
Behavioral Symptoms
Mood Disorders
Mental Disorders