This document discusses neuromodulation techniques for psychiatric disorders, including deep brain stimulation (DBS) and vagus nerve stimulation (VNS). It provides an overview of DBS and VNS indications for various psychiatric conditions such as OCD, depression, Tourette's syndrome, and more. The document also describes specific DBS and VNS cases from Italy for conditions like OCD, depression, and chronic pain. It discusses the state of the field and guidelines for ethical surgery for psychiatric disorders.
Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathyMCH-org-ua
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathyMCH-org-ua
International conference «Actual approaches to the extremely preterm babies: International experience and Ukrainian realities» (Kyiv, Ukraine, March 5-6, 2013)
Parkinsons Disease Psychosis (PDP) is a multifactorial, progressive disease that presents in the late stages of Parkinsons Disease. Its hallmark features include visual hallucinations and delusions. There are factors related to Parkinsons medications (i.e. L-DOPA, anticholinergics) as well as intrinsic disease-related factors that contribute to the psychosis.
By the end of this presentation, learners will be able to:
Develop and refine a differential diagnosis for peripheral neuropathy.
Discuss the workup for common & typical cases.
Perform a comprehensive diabetic foot exam by ADA/NDEP standards.
Treat painful peripheral neuropathy.
Parkinsons Disease Psychosis (PDP) is a multifactorial, progressive disease that presents in the late stages of Parkinsons Disease. Its hallmark features include visual hallucinations and delusions. There are factors related to Parkinsons medications (i.e. L-DOPA, anticholinergics) as well as intrinsic disease-related factors that contribute to the psychosis.
By the end of this presentation, learners will be able to:
Develop and refine a differential diagnosis for peripheral neuropathy.
Discuss the workup for common & typical cases.
Perform a comprehensive diabetic foot exam by ADA/NDEP standards.
Treat painful peripheral neuropathy.
DIAGNOSA BANDING PENURUNAN KESADARAN MANAJEMEN
Dipresentasikan oleh Jofizal Jannis | Neurologist| National Brain Centre
pada PIT VI IDI Kota Bogor | 10 Nopember 2013
lecture 28 from a college level introduction to psychology course taught Fall 2011 by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University, includes drugs, electroconvulsive therapy
Complex regional pain syndrome is a multifactorial syndrome of pain affecting mainly limbs (Upper>lower) and other body parts. Females are affected more than males (4:1). No definitive investigation is available. Early treatment is better to avoid consequences and complications.
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Identification and nursing management of congenital malformations .pptx
Giovanni Broggi
1. NEUROMODULATION
in Psychiatric Disorders
Giovanni Broggi,
Dept of Neurosurgery
Fond. Istituto Neurologico C.Besta
Milano Italy
A LONG SHADOW OVER THE SOUL
- Fano –March 29-31,2012
2. NEUROMODULATION
in Psychiatric Disorders
• Deep Brain Stimulation –DBS
Different targets
• Vagal Nerve Stimulation-- VNS
3. NEUROMODULATION in Psychiatric Disorders
DBS
Indications:
•OCD
•DISRUPTIVE BEHAVIOUR
•SOMATOFORM DISORDERS
•MAYOR DEPRESSION
•Gilles de la TOURETTE
VNS
Indication:
MAYOR DEPRESSION
4. WHAT IS THE STATE OF ART
of Surgery for Psychiatric Disorders the World?
World Federation Societies Stereo-Functional Neurosurgery
INTERNATIONAL FORUM OF PSYCHIATRIC SURGERY
SHANGHAI, MARCH 9-11, 2011
Neurosurgery for Psychiatric Diseases in Italy
Giovanni Broggi
Dept of Neurosurgery
Fond. Istituto Neurologico C.Besta
Milano, Italy
5. DBS
• Milano Besta
– 7 cases for aggressive behavior (post Hyp)
– 5 cases of OCD ( ACC)
– 1 case somatoform disease, pain ( B.A.24)
– 3 cases of major depression ( B.A. 25)
– 5 case of Gilles Tourette ( GPi // cortex B.A.9-46)
• Milano Galeazzi
– 32 case of Gilles Tourette (Vop-CM // Gpi)
VNS for Major Depression
Milano Besta 21 cases
Torino Univ 11 cases
Udine Hospital 6 cases 2011
6. Neurosurgery for Psychiatric Diseases
WSSFN ad hoc Committe for Ethical Guidlines
Mood & Mind Supplementum
World Neurosurgery 2012
•Surgery for Psychiatric Disoeders
D.A.J.P.Denys- Amsterdam
•Surgery in Tourette Syndroem
Vaerle Visser-Vandevalle-Maastricht
•DBS for OCD
Stephane Chabardes- Grenoble
•DBS for Alcool dependency
J.Voges- Maagdeburg
7. DELGADO, M. R., H. HAMLIN and W. P.
CHAPMAN.
Technique of intracranial electrode
implacement for recording and stimulation
and its possible therapeutic value in
psychotic patients.
Conf. neurol., 12:315-319, 1952.
8.
9. INCB Criteria of Patiens selection
• Diagnosis by the referral psychiatrist
• Control and agreement on the diagnosis
by two indipendent psychiatrist
• Neuroradiological studies
• Team ( psychiatrist, neurologist, neurosurgeons)
discussion and agreement
• Informed consensus to surgery
( patient , family or legal tutor)
10. Deep brain stimulation of the accumbens nucleus
In treatment of obsessive compulsive diseases.
Preliminary experiences
11.
12. Coordinates of Nucleus Accumbens:
2.5 mm rostral anterior border of
AC (Z)
6.5 mm lateral of midline (X)
- 4.5 mm ventral AC (Y)
15. Microrecording on Nucleus Accumbens
70-200ms
μV
Spikess
1
Time (s) 1s
No discharge specific pattern in NA Time (s)
With thw exception of few neurons with discharge frequency of 15Hz
But with some episode of ~200Hz (doublets) frquency
20. ?
Follow up In Patient 2: Decrease of YBOCS score from 30 to 12
Increase of GAF score from 41 to 60
21.
22.
23.
24. Results on QoL
BOTH PATIENTS REFRACTORY TO CONSERVATIVE TREATMENT
BOTH PATIENTS SELECTED BY TWO INDEPENDENT PSYCHIATRIC TEAMS
BOTH PATIENTS OBTAINED SIGNIFICANT IMPROVEMENT BY DBS
BOTH PATIENTS REGAINED SOCIAL LIFE
(work , friends , hobbies…)
~~~~~~~~~~~
ONE PATIENTS IS REALLY SATISFIED
(“I have been cured”)
ONE PATIENTS IS NOT SATISFIED
(“still I feel me unhappy , sick..”)
25. Hypothalamic neuromodulation
for aggressive behaviour
ANGELO FRANZINI GIUSEPPE MESSINA
CARLO MARRAS GIOVANNI TRINGALI GIOVANNI BROGGI
26. The Problem
Rage attacks , self aggression , and disruptive
behaviour
resistent to conservative treatments
in mentally retarded patients
---------
connatal idiopathic
brain damage ( trauma , encephalitis)
----------
Frequent comorbidity for epilepsy
28. Sano K. 1970
Franzini et al. 2003
May A. 1999
The Sano graphic reconstruction of electrodes tracks and the fusion
between RM and postoperative CT with electrodes implanted
within the posterior hypothalamus
35. THE FIRST CASE Clinical Case : 34 yrs old male
Mental retardation : iQ < 40
Refractory epilepsy
INTRACTABLE DISRUPTIVE BEHAVIOUR isolation (4 years)
Neuroleptics drowsisness – epilepsy – tardive dystonia
Withdrawald of neuroleptics
Two weeks after surgery
Recover of
social activities two months
after surgery
Decrease of seizures rate 50%
(neuroleptics ?)
no more isolation
four years follow-up
36. Posteromedial hypothalamic stimulation for aggressive
and disruptive behaviour in IQ subaverage patients
2004 – 2008
6 patients
patients aetiology age epilepsy neuroimaging
IQ
1 P.G. Idiopathic 26 Not evaluable multifocal no Normal
2 B.A. Perinatal 34 Not evaluable no no Normal
Toxoplasmosis
3 P.M. Idiopathic 21 40 no no Normal
Post-anoxia 64 30 no Insomnia Bilateral frontal cortical
4 C.A. Severe arterial atrophy
hypertension
5 D.C. Post-traumatic 37 Not evaluable no no Bilateral temporal
porencephaly
6 C.C. Idiopathic 20 30 multifocal no Normal
RESPONDERS
NON RESPONDERS
37.
38. LONG TERM RESPONDERS (67%)
-Neuroleptics dosage decrease > 50%
-No more Hospitalization
-No more contentive measures
-Family or therapeutic community stay
-Improvement of cognitive functions
-Marked reduction of epileptic seizures (2 epileptics)
-Adverse effects
--Slight worsening of neck dystonia (2 patients) when
stimulating with the most caudal contact
--Impairement of ocular movements when the current
amplitude > 3 Volts
39.
40. DISAPPEARANCE OF SELF-AGGRESSIVE BEHAVIOR IN A BRAIN-INJURED PATIENT
AFTER DEEP BRAIN STIMULATION OF THE HYPOTHALAMUS:
TECHNICAL CASE REPORT.
Neurosurgery. 62(5):E1182, May 2008.
Kuhn, Jens M.D.; Lenartz, Doris M.D.; Mai, Jurgen K. M.D.; Huff, Wolfgang M.D.;
Klosterkoetter, Joachim M.D.; Sturm, Volker M.D
42. Somatoform Disorders
Common Characteristics
Disorders in this category include those where
the symptoms suggest
a medical condition but where no medical condition
can be found by a physician.
In other words, a person with a somatoform disorder
might experience significant pain without
a medical or biological cause,
or they may constantly experience minor aches
and pains without any reason for these pains to exist.
43. Somatoform Disorders
Prognosis
Poor. The course is typically chronic
and persists for years, and often
involves other symptoms such as
depression, anxiety, and drug abuse .
47. Nature Neuroscience 2, 403 - 405 (1999)
doi:10.1038/8065
Pain-related neurons in the human cingulate cortex
W. D. Hutchison1, K. D. Davis, A. M. Lozano
R. R. Tasker1 & J. O. Dostrovsky
50. Deep Brain Stimulation of the Anterior Cingulate Cortex (ACC)
Brodman area 24
ATYPICAL FACIAL PAIN
51.
52.
53. 60 years female patient
More than 10 years of chronic pain of the face perioral area
Refractory to any kind of drugs treatment including opioids ,
neuroleptics ,antiepileptics etc..
No social life , completely invalidated
After four months of high frequency stimulation of the
Cingulate cortex (Brodman area 24) the patient became
pain free
At 3 year, follow-up still control of pain,
that became episodic instaed of continous
59. Case 1 46 years old , male
Diagnosis of bipolar depression 22 years old (one maniac episode)
Psychoterapy
Drug therapy
ECT (6 times)
VNS (2 years)
HRDS 1 = 32
HRDS 1 = 5
18 months follow-up
Patients and relatives satisfied
60. DBS for Psychiatric Disorders at Besta
Area 25
Area 24
P Hyp
N ACC
www.angelofranzini.com
65. VNS:
Modification of regional functional anatomy
Main conceptual benchmarks in the genesis of depression:
- imbalance in the prefrontal-limbic circuit
-VNS could modify such balance
Functional Magnetic Resonance (fMRI) may evidence the
immediate effects of VNS
SPECT and PET may evidence long-term effects
66. VNS
modification of regional functional anatomy
fMRI (Chae et al. , 2002)
•At VNS immediate activation
• Prefrontal gyri, Caudate nuclei,
• temporal and parietal lobes,
Cerebellum
•After 2 weeks of VNS : Frontal and Temporal Lobes
Occipital Lobe and Cerebellum
67. PET STUDIES Blood flow increases: yellow
1
Blood flow decreases: blue
Acute VNS study with PET
images superimposed on
MRI images:
1: High frequency stimulation
group
2
2: Low frequency stimulation
group
(Henry T, 2002)
68. 74 European patients with therapy-resistant major depressive
disorder.
Psychometric measures were obtained after 3, 12, and 24
months of VNS.
Journal of Clinical Psychopharmacology & Volume 30, Number 3, June 2010
69. Mixed-model repeated-measures analysis of variance revealed a
significant reduction (P ≤ 0.05) at all the 3 time points in the 28-
item Hamilton Rating Scale for Depression (HRSD28) score
•53.1% (26/49) of the patients fulfilled the response criteria
(Q50% reduction in the HRSD28 scores from baseline)
• 38.9% (19/49) fulfilled the remission criteria
(HRSD28 scores e 10).
70. From January 2004 to November 2006 fourteen patients with TRD
(age 43 to 80; ten men and four women) underwent VNS
• Baseline scores: ≥ 20 on HDRS21.
• All of them had failed at least four antidepressant trials
in their current major depressive episode
3. They did not benefit from a minimum of 6 months of psychotherapy
and their current episode was lasting for at least two years.
71. 60
Pat 1
50 Pat 2
Pat 3
40 Pat 4
HRSD
Pat 5
Pat 6
30 Pat 7
Pat 8
20 Pat 9
Pat 10
Pat 11
10 Pat 12
Pat 13
Pat 14
0
nt
th
th
th
th
s
s
s
s
yr
yr
yr
yr
a
m
m
m
m
pl
2
4
6
7
12
1
4
8
Im
Time
Diagram of ongoing of HDRS21 score in 14 patients with a follow-up of at least 1 year, as a function of time.
Arrow indicates the clinical worsening of patient 2 which occurred after IPG’s Battery Depletion
Responders ( HRSD21 < 50 %) : 71%
72. VNS For Depressive Disorder
Results:
:HRSD 21 score ≤ 50 % of baseline score (responsiveness)
HRSD 21 score < 10 as absolute value (remittance)
4 patients did not responde to either criteria
10 Patients responded to the responsiveness criterion
(HRSD 21 score ≤ 50 % of baseline score )
7 out of these 10 patients also met the criterion for remittance
(HRSD 21 score < 10 as absolute value)
73. acknowledgement
• Angelo Franzini
• Giuseppe Messina
• Giovanni Tringali
• Morgan Broggi
• Orsola Gambini
• Carlo Marras
• Vittoria Nazzi