Ignite Creation Date:
2024-05-06 @ 1:22 AM
Last Modification Date:
2024-10-26 @ 11:03 AM
Study NCT ID:
NCT01798407
Status:
ACTIVE_NOT_RECRUITING
Last Update Posted:
2023-09-13
First Post:
2013-02-21
Brief Title:
DBS of the Lateral Habenula in Treatment-Resistant Depression
Sponsor:
Wayne Goodman MD
Organization:
Baylor College of Medicine
Study Overview
Official Title:
A Clinical Pilot Study Examining Bilateral Inhibition of the Lateral Habenula As a Target for Deep Brain Stimulation in Intractable Depression
Status:
ACTIVE_NOT_RECRUITING
Status Verified Date:
2024-09
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
No
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
This research study will investigate the safety tolerability and benefit of bilateral deep brain stimulation DBS to the lateral habenula in subjects with treatment-resistant major depression TRD secondary to either nonpsychotic unipolar major depressive disorder MDD or bipolar disorder BD I Six adult subjects with TRD will be treated in this single-site study at Baylor College of Medicine subjects will be chronically symptomatic with significant functional disability and will have demonstrated resistance to standard somatic and pharmacotherapeutic treatments The primary outcome measure will be the change in the 17-item Hamilton Depression Rating Scale HDRS17 six months after the commencement of stimulation
Detailed Description:
This research study includes the following parts 1 medical psychiatric and cognitive evaluations 2 implantation of the brain stimulation system and 3 follow up including programming and psychiatric testing after the implantation
1 Medical psychiatric and cognitive evaluations
For those subjects that are found to be eligible and agree to participate in the study they will be asked more detailed questions about their symptoms mood and thinking on another visit before receiving the implantation The investigator will ask detailed questions about the subjects psychiatric and medical history and will ask for a list of medications along with response to previous treatments The subject will also be asked to fill out several questionnaires
Subjects will be asked to give a sample of both blood and urine for standard lab evaluations All subjects will be tested for the presence of drugs of abuse in their urine All women of child bearing potential will also be tested for pregnancy If any of the test results are positive the subject cannot continue to be part of this study but can receive other standard clinical care by a treating psychiatrist
As part of the pre-operative clinical evaluation all subjects will be evaluated by a neurosurgeon and potentially a medical specialist for surgical optimization as well as an anesthesiologist for an intra-operative risk assessment Prior to surgery an independent evaluator who is not affiliated with the research study will confirm the diagnosis of MDD and assess the subjects understanding of the risks of the surgery and follow-up care
Additionally subjects will have two pre-surgical magnetic resonance imaging MRI scans This is to ensure accurate placement of the system leads and will take place the the month before surgery Subjects will also have neuropsychological testing cognitive tests of memory and thinking skills before and after surgery
2 Implantation of the brain stimulation system
The brain stimulation system is implanted inside the subjects body The implanted system is made up of three major parts
The leads are made of four insulated wires with four electrodes at the end
The extensions connect the lead to the neurostimulator power source
The neurostimulator battery is the power source of the system
The neurostimulator is a metal can which depending on the model the subject receives will be in the range of about 2 or 3 inches in diameter and about ½ inch thick It contains a small battery and produces the electrical impulses needed for stimulation For this study a rechargeable battery will be used this battery cannot be replaced without replacing the entire neurostimulator Replacing the neurostimulator involves minor surgery Although battery life varies for each subject depending on the type and intensity of stimulation needed for good symptom relief the use of a rechargeable battery will extend the time before it must be replaced A hand held control magnet is used to turn the therapy on and off
Subjects will have two leads and one neurostimulator implanted The surgeon may place the neurostimulator either near the collarbone or within the abdomen
Devices will be implanted in a staged fashion meaning that subjects will have each lead placed in one individual procedure The lead extensions and neurostimulator will be placed during the second procedure after the second lead has been placed The lead implant surgeries will take place approximately 1-2 weeks apart On the evenings before surgeries subjects may be instructed to stop taking all of their medications This is so the effect of the deep brain stimulation on the subjects symptoms can best be determined Subjects will be admitted to the hospital the mornings of each surgery and may have their head shaved prior to surgery to help prevent infection Additionally the surgical team will assess the subjects emotional and physical status on the morning of the second surgery and will notify the study team if there are any concerns
The day of each surgery the following steps may occur
1 Pictures of the brain will be taken using computer-aided tomography CT scans and 3D imaging This will be combined with the previous MRI scans and allow the surgeon to determine the area in the brain where the leads will be placed A CT scan - also called CT or computerized tomography - is an X-ray procedure where a high-speed computer is used to make multiple images or pictures of the body Subjects will be asked to lie still on a table and at time may have to hold their breath for a few seconds in order to avoid blurring the pictures Subjects may have 1 CT scan before and after each surgery to ensure the leads are in the correct locations on the brain
2 In the operating room a metal frame will be attached to the head The frame is a special instrument that allows the surgeon to find the correct path to the target site in the brain Local anesthetic will be given so that the pins which hold the frame to the head do not hurt
3 Subjects will be positioned on the operating table and a catheter will be inserted and antibiotics will be given through an intravenous IV line placed in the arm Vital signs will be monitored The metal frame attached to the subjects head will also be attached to the operating table for safety The subjects head will be sterile prepared for the procedure
4 A small hole will be drilled in the skull for the lead to be implanted that day 2 total leads placed 1 at a time on 2 separate surgery days The subject will receive local anesthesia before this procedure
5 The lead is then passed into the brain to the desired site Test stimulation will be performed to determine if there are unwanted side effects Once test stimulation is complete the device will be turned off until the entire system has been implanted ie both leads extensions and neurostimulator and the subject has recovered from the surgeries
6 A cap will be placed over the hole in the skull The cap also holds the lead in position
7 The metal frame is then removed from the subjects head
8 After the implantation procedures additional CT brain imaging will be performed
9 The extensions and neurostimulator will be placed during the second surgery about two weeks following the first surgery after the second lead has been placed on the other side of the brain This part is performed under general anesthesia Some additional blood tests may be performed to confirm the subject is stable
The subject will be admitted the morning of surgery and stay in the hospital overnight after each surgery They will typically be discharged the next day once it is determined that they are in stable condition
Interim Clinical Assessment If the second surgery is to be performed within 2 weeks of the first surgery the subject may not have an interim clinical assessment performed However if your second stage surgery is scheduled 2 weeks or more after the first stage this visit will be performed During this visit the subject will be evaluated on recovery from the first surgery and asked about depressive symptoms Subjects will also be asked to fill out several questionnaires This visit will take place at the Baylor Psychiatry Clinic and will last approximately one hour
Either way for both surgeries standard surgical follow up procedures will be followed The surgical team will follow up with the subject after each surgery on the day they have surgery and prior to discharge while they are still in the hospital The surgical team will also follow up with the subject within a week of discharge They will assess the subjects emotional and physical status and will bring the subject in as soon as possible for further evaluation if there are any concerns
3 Follow-up programming and psychiatric assessments The study physician see subjects for follow up after surgery Follow up visits are scheduled after subjects are implanted During these visits the study physicians or other clinicians will assess the subjects condition using various standardized questionnaires
Frequent non-invasive adjustment to the stimulation parameters may be required to achieve optimal symptom response This adjustment period may take weeks or months
The DBS device will be turned on during the first programming visit with the study doctor about 2 weeks after the second surgery
4 Duration of treatment The optimization period generally lasts about 8 weeks after which modulation appointments are scheduled monthly or on an as needed basis A CT scan will be performed at Month 3 to check on the placement of the subjects leads The subject will receive up to 5 total CT scans 1 CT scan before and after each surgery and 1 CT scan at the 3-month checkup mark These 5 CT scans are to ensure the leads are in the correct locations of the subjects brain If a subject responds to the treatment stimulation may be temporarily discontinued between months 12 and 18 to find out if the response is because of the treatment The subject will not be told when this discontinuation occurs and they will be carefully monitored during this time seen approximately every 2 weeks If symptoms worsen the subject will be informed if stimulation was discontinued and they will have the option to have stimulation restarted If the subject continues to do well without stimulation they may be offered the opportunity to continue without stimulation consider removing the device or to restart stimulation
For subjects that do not respond to the DBS treatment the system will remain implanted unless the subject desires for it to be removed or it is medically necessary that it be removed After the End of the Study Month 18 the device will remain implanted in subjects that are doing well clinically
Because the battery life is approximately 7-9 years every 7-9 years batteries will need to be replaced This requires subjects to undergo a brief surgery to have the neurostimulator replaced - the neurostimulator contains a small rechargeable battery and produces the electrical impulses needed for stimulation When the battery can no longer be recharged the neurostimulator must be replaced Once a subject has exited the study their insurance may not pay for device replacements or other medical care related to the device
1 Medical psychiatric and cognitive evaluations
For those subjects that are found to be eligible and agree to participate in the study they will be asked more detailed questions about their symptoms mood and thinking on another visit before receiving the implantation The investigator will ask detailed questions about the subjects psychiatric and medical history and will ask for a list of medications along with response to previous treatments The subject will also be asked to fill out several questionnaires
Subjects will be asked to give a sample of both blood and urine for standard lab evaluations All subjects will be tested for the presence of drugs of abuse in their urine All women of child bearing potential will also be tested for pregnancy If any of the test results are positive the subject cannot continue to be part of this study but can receive other standard clinical care by a treating psychiatrist
As part of the pre-operative clinical evaluation all subjects will be evaluated by a neurosurgeon and potentially a medical specialist for surgical optimization as well as an anesthesiologist for an intra-operative risk assessment Prior to surgery an independent evaluator who is not affiliated with the research study will confirm the diagnosis of MDD and assess the subjects understanding of the risks of the surgery and follow-up care
Additionally subjects will have two pre-surgical magnetic resonance imaging MRI scans This is to ensure accurate placement of the system leads and will take place the the month before surgery Subjects will also have neuropsychological testing cognitive tests of memory and thinking skills before and after surgery
2 Implantation of the brain stimulation system
The brain stimulation system is implanted inside the subjects body The implanted system is made up of three major parts
The leads are made of four insulated wires with four electrodes at the end
The extensions connect the lead to the neurostimulator power source
The neurostimulator battery is the power source of the system
The neurostimulator is a metal can which depending on the model the subject receives will be in the range of about 2 or 3 inches in diameter and about ½ inch thick It contains a small battery and produces the electrical impulses needed for stimulation For this study a rechargeable battery will be used this battery cannot be replaced without replacing the entire neurostimulator Replacing the neurostimulator involves minor surgery Although battery life varies for each subject depending on the type and intensity of stimulation needed for good symptom relief the use of a rechargeable battery will extend the time before it must be replaced A hand held control magnet is used to turn the therapy on and off
Subjects will have two leads and one neurostimulator implanted The surgeon may place the neurostimulator either near the collarbone or within the abdomen
Devices will be implanted in a staged fashion meaning that subjects will have each lead placed in one individual procedure The lead extensions and neurostimulator will be placed during the second procedure after the second lead has been placed The lead implant surgeries will take place approximately 1-2 weeks apart On the evenings before surgeries subjects may be instructed to stop taking all of their medications This is so the effect of the deep brain stimulation on the subjects symptoms can best be determined Subjects will be admitted to the hospital the mornings of each surgery and may have their head shaved prior to surgery to help prevent infection Additionally the surgical team will assess the subjects emotional and physical status on the morning of the second surgery and will notify the study team if there are any concerns
The day of each surgery the following steps may occur
1 Pictures of the brain will be taken using computer-aided tomography CT scans and 3D imaging This will be combined with the previous MRI scans and allow the surgeon to determine the area in the brain where the leads will be placed A CT scan - also called CT or computerized tomography - is an X-ray procedure where a high-speed computer is used to make multiple images or pictures of the body Subjects will be asked to lie still on a table and at time may have to hold their breath for a few seconds in order to avoid blurring the pictures Subjects may have 1 CT scan before and after each surgery to ensure the leads are in the correct locations on the brain
2 In the operating room a metal frame will be attached to the head The frame is a special instrument that allows the surgeon to find the correct path to the target site in the brain Local anesthetic will be given so that the pins which hold the frame to the head do not hurt
3 Subjects will be positioned on the operating table and a catheter will be inserted and antibiotics will be given through an intravenous IV line placed in the arm Vital signs will be monitored The metal frame attached to the subjects head will also be attached to the operating table for safety The subjects head will be sterile prepared for the procedure
4 A small hole will be drilled in the skull for the lead to be implanted that day 2 total leads placed 1 at a time on 2 separate surgery days The subject will receive local anesthesia before this procedure
5 The lead is then passed into the brain to the desired site Test stimulation will be performed to determine if there are unwanted side effects Once test stimulation is complete the device will be turned off until the entire system has been implanted ie both leads extensions and neurostimulator and the subject has recovered from the surgeries
6 A cap will be placed over the hole in the skull The cap also holds the lead in position
7 The metal frame is then removed from the subjects head
8 After the implantation procedures additional CT brain imaging will be performed
9 The extensions and neurostimulator will be placed during the second surgery about two weeks following the first surgery after the second lead has been placed on the other side of the brain This part is performed under general anesthesia Some additional blood tests may be performed to confirm the subject is stable
The subject will be admitted the morning of surgery and stay in the hospital overnight after each surgery They will typically be discharged the next day once it is determined that they are in stable condition
Interim Clinical Assessment If the second surgery is to be performed within 2 weeks of the first surgery the subject may not have an interim clinical assessment performed However if your second stage surgery is scheduled 2 weeks or more after the first stage this visit will be performed During this visit the subject will be evaluated on recovery from the first surgery and asked about depressive symptoms Subjects will also be asked to fill out several questionnaires This visit will take place at the Baylor Psychiatry Clinic and will last approximately one hour
Either way for both surgeries standard surgical follow up procedures will be followed The surgical team will follow up with the subject after each surgery on the day they have surgery and prior to discharge while they are still in the hospital The surgical team will also follow up with the subject within a week of discharge They will assess the subjects emotional and physical status and will bring the subject in as soon as possible for further evaluation if there are any concerns
3 Follow-up programming and psychiatric assessments The study physician see subjects for follow up after surgery Follow up visits are scheduled after subjects are implanted During these visits the study physicians or other clinicians will assess the subjects condition using various standardized questionnaires
Frequent non-invasive adjustment to the stimulation parameters may be required to achieve optimal symptom response This adjustment period may take weeks or months
The DBS device will be turned on during the first programming visit with the study doctor about 2 weeks after the second surgery
4 Duration of treatment The optimization period generally lasts about 8 weeks after which modulation appointments are scheduled monthly or on an as needed basis A CT scan will be performed at Month 3 to check on the placement of the subjects leads The subject will receive up to 5 total CT scans 1 CT scan before and after each surgery and 1 CT scan at the 3-month checkup mark These 5 CT scans are to ensure the leads are in the correct locations of the subjects brain If a subject responds to the treatment stimulation may be temporarily discontinued between months 12 and 18 to find out if the response is because of the treatment The subject will not be told when this discontinuation occurs and they will be carefully monitored during this time seen approximately every 2 weeks If symptoms worsen the subject will be informed if stimulation was discontinued and they will have the option to have stimulation restarted If the subject continues to do well without stimulation they may be offered the opportunity to continue without stimulation consider removing the device or to restart stimulation
For subjects that do not respond to the DBS treatment the system will remain implanted unless the subject desires for it to be removed or it is medically necessary that it be removed After the End of the Study Month 18 the device will remain implanted in subjects that are doing well clinically
Because the battery life is approximately 7-9 years every 7-9 years batteries will need to be replaced This requires subjects to undergo a brief surgery to have the neurostimulator replaced - the neurostimulator contains a small rechargeable battery and produces the electrical impulses needed for stimulation When the battery can no longer be recharged the neurostimulator must be replaced Once a subject has exited the study their insurance may not pay for device replacements or other medical care related to the device
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
True
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None
Secondary IDs
| Secondary ID | Type | Domain | Link |
|---|---|---|---|
| GCO 12-1815 | OTHER | MSSM IRB | None |
| 49593 | OTHER | None | None |
| 277909 | OTHER | None | None |
| HSM12-00467 | OTHER_GRANT | None | None |