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Hope for those with treatment resistant depression

by Maggie Mullen
Public Relations
MUSC researchers have become national leaders with a new neurosurgical procedure. The teamwork among Ziad Nahas, M.D., Istvan Takacs, M.D., and Scott Reeves, M.D., helped to pioneer bilateral epidural prefrontal cortical stimulation (EpCS) in the brain, which proved generally safe and provided significant improvement of depressive symptoms.
Dr. Istvan Takacs points out the computer image of a bilateral epidural prefrontal cortical stimulation (EpCS) in the brain to Drs. Ziad Nahas, center, and Scott Reeves. This work was funded by the National Alliance of Research in Schizophrenia and Affective Disorders, while a local resource, General Clinical Research Center, was critical in covering perioperative costs. The devices were donated by Medtronic Inc.
For information, call

“Cortical stimulation is reversible, non-destructive and potentially safer than other forms of invasive brain stimulation since the stimulating paddles do not come in direct contact with the brain,” said Nahas, associate professor of Psychiatry, Physiology and Neuroscience and director of MUSC's Mood Disorders Program. “These preliminary results are encouraging but not definitive. Now that we have a proof of concept, we should aim at studying bilateral EpCS in larger placebo-controlled studies.”
Pushing this idea for four years, Nahas is the principal investigator who collaborated with both Takacs and Reeves. The study consisted of implanting EpCS into five patients over the anterior frontal poles and the lateral prefrontal cortex. These areas are important in regulating mood and social behavior. Paddle leads were then connected to small generators surgically implanted into the chest area. Patients were followed over a seven-month period as the devices periodically delivered low electrical charges, which were individualized for each, and then were evaluated using standard clinical ratings. Only patients who have tried several medications and treatments without success were included in the study.
“The more sophisticated functions are on the surface of the brain,” said Takacs. “We are trying to change the climate within the prefrontal cortex so it could exert more adaptive governance of deeper brain regions,” he said.
The average improvement was between 50 to 60 percent based on varying measures. Three patients reached remission.
“This groundbreaking pilot study emphasizes the synergism that can occur when multiple departments and researchers come together to develop possible solutions to complex clinical problems, such as refractory depression,” said Reeves.
Nahas’ immediate team involved Berry Anderson, Ph.D., and Ashley Arana. Other contributors were Mark George, M.D., Distinguished University Professor, Department of Psychiatry and Behavioral Science, and Jeff Borckardt, Ph.D., associate professor, Department of Psychiatry and Behavioral Science. The departments of Psychiatry and Behavioral Science, Neurosurgery, and Anesthesia and Perioperative Medicine collaborated to make this possible.
For more information, call 876-5142.

Friday, Nov. 27, 2009

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