Personalized Adaptive Cortical Electro-stimulation (PACE) in Treatment-Resistant Depression

  1. Ziad Nahas
  2. Robert Hermosillo
  3. Spencer H. Eiting
  4. Tariq Hattab
  5. Maya Hazimeh
  6. Rachel A. Johnson
  7. Thomas Madison
  8. Kimberly B. Weldon
  9. Seth Koenig
  10. Cash Differding
  11. Ahmed Sakr
  12. Butool Durrani
  13. Sanju Koirala
  14. Jeremy Chaikind
  15. Eric Waldron
  16. Nicholas M. Arnoudse
  17. Oscar Miranda-Domínguez
  18. Brenden Tervo-Clemmens
  19. Bart Larsen
  20. Richard Betzel
  21. Eric Feczko
  22. Lucille A Moore
  23. Julia Moser
  24. Jacob T. Lundquist
  25. Gracie J Grimsrud
  26. Nora Byington
  27. Kristina Hufnagle
  28. Charles Lynch
  29. Conor Liston
  30. Scott Marek
  31. Evan M. Gordon
  32. Timothy Laumann
  33. Alexander B Herman
  34. Alik Widge
  35. Michael C. Park
  36. Nico U. F. Dosenbach
  37. Steven M Nelson
  38. David P Darrow
  39. Theoden I. Netoff
  40. Damien Fair
0 evaluations Published on
Read the full article Related papers
This article on Sciety

Abstract

Treatment-resistant depression (TRD) is a leading cause of premature death. For decades investigators have assessed the clinical efficacy of direct brain stimulation for TRD. Outcomes have been inconsistent due to imprecise brain targeting. Minimally invasive Personalized Adaptive Cortical Electro-stimulation (PACE) uses fMRI-based precision functional mapping (PFM) to target patient-specific network anomalies with brain surface electrodes. We utilized this novel technology in an n-of-1 study to treat a 44-year-old man (TRD-1) with over 30 years of severe unipolar depression. PFM revealed a 400% expansion in cortical area of the Salience Network (SN) and a 25% reduction in default mode (DMN) and frontoparietal (FP) networks compared to a group average controls. Stimulation paddles were implanted targeting patient-specific SN, DMN, and FP networks. Postoperative stimulation testing (within 24h) revealed immediate electrode-specific mood and cognition responses that matched the underlying functional networks. Stimulation parameters were iteratively optimized using ‘Bayes Tuning’ based on patient feedback. TRD-1’s suicidal ideations ceased within 7 weeks. Full remission of symptoms was achieved within 9 months and maintained at 30 months. PACE therapy appears to be a scalable, safe, and cost-effective approach to treat TRD.

Related articles

Related articles are currently not available for this article.