Scientists in the Neurological Surgery and Psychiatry Departments at UT Southwestern Medical Center are engaged in three separate clinical trials to test the efficacy of deep brain stimulation against depression and schizophrenia.
Deep brain stimulation for depression
The two depression-related trials, Tractography Guided Subcallosal Cingulate Deep Brain Stimulation for Treatment Resistant Depression and Deep Brain Stimulation (DBS) for Depression Using Directional Current Steering and Individualized Network Targeting are led by Nader Pouratian, M.D., Ph.D., Chair and Professor of Neurological Surgery. The latter trial has National Institutes of Health (NIH) funding from the BRAIN initiative and is in collaboration with Baylor College of Medicine faculty members Sameer Sheth, M.D., Ph.D., and Wayne Goodman, M.D.
“Treatment resistant depression does not have many treatment options,” Dr. Pouratian said. “Our interventional psychiatry team is evaluating an array of treatments, including vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, and electroconvulsive therapy. Deep brain stimulation is yet another tool to help treat these patients. Ultimately, our goal is to understand which treatments work, and which are ideal for which patients, so we can treat patients with the best therapy sooner.”
These two studies build off previous work from the Pouratian Lab, which uses brain mapping technology to establish biomarkers of disease and find innovative approaches to restoring function to patients with neurological and psychiatric diseases. The same imaging technique is being used to differentiate people who respond and those who do not respond to electroconvulsive therapy. The imaging technique may not only be useful to help target and improve outcomes with deep brain stimulation, but also may help select ideal candidates for treatment.
These studies have enrolled two patients to date and are still collecting data. The goal is to provide a long-term therapy for patients with resistant and recurrent depression.
“We are creating a future and better care for patients who do not have many other treatment options,” Dr. Pouratian added. “We have designed and are running the trials – that uniquely sets UT Southwestern apart.”
Deep brain stimulation for schizophrenia
The schizophrenia-related trial, Closed Loop Neuromodulation for Treatment-Refractory Schizophrenia: A Pilot Study, is led by Bradley Lega, M.D., Associate Professor of Neurological Surgery, Neurology, and Psychiatry, and Dr. Pouratian in collaboration with Carol Tamminga, M.D., Chair and Professor of Psychiatry. The trial is funded by an innovation grant provided by the Peter O’Donnell Jr. Brain Institute.
The trial is based on brain stimulation strategies developed by Dr. Pouratian for the treatment of refractory depression and Dr. Lega for memory restoration. Dr. Tamminga’s expertise in schizophrenia-related brain circuits will aid in applying these techniques to schizophrenia.
“This study has the potential to unlock an entirely new therapeutic strategy for patients with schizophrenia,” Dr. Lega said. “It will also generate first-of-its-kind brain mapping data to understand the brain circuits underlying schizophrenia.”
Patients suffering from devastating conditions like schizophrenia often do not find relief with existing therapies. Using an innovative application of neuromodulation, this trial combines the multidisciplinary expertise of psychiatry, neurosurgery, cognitive neuroscience, and neural engineering to map brain circuits and ultimately devise patient-specific treatment.
Learn more about our trials
Tractography Guided Subcallosal Cingulate Deep Brain Stimulation for Treatment Resistant Depression
Nader Pouratian, M.D., Ph.D., Chair and Professor of Neurological Surgery, and his team developed a novel method for optimizing targeting of deep brain stimulation for depression. Unlike traditional targeting, this method relies on analyzing and pinpointing brain connections that seem to be critical for improving symptoms of depression. In collaboration with the UT Southwestern interventional psychiatry team, led by Kala Bailey, M.D., Assistant Professor of Psychiatry, Dr. Pouratian is conducting a trial of deep brain stimulation for treatment resistant depression using this novel targeting technique. The team believes using this cutting-edge approach to stimulate these key pathways will significantly increase the chance of improvement in patients’ symptoms. The trial has enrolled two patients and aims to enroll up to 12 participants.
Deep Brain Stimulation (DBS) for Depression Using Directional Current Steering and Individualized Network Targeting
In another innovative trial applying deep brain stimulation to depression, Dr. Pouratian is collaborating with Baylor College of Medicine faculty members Sameer Sheth, M.D., Ph.D., and Wayne Goodman, M.D., to evaluate a different approach. The team aims to use advanced brain mapping techniques to better understand how depression affects the brain and how stimulation affects brain activity. During a 10-day hospitalization, patients have their brain activity recorded continuously as they perform various tasks and undergo different types of stimulation. The goal is to link these two critical sources of knowledge to design more precise and physiologically guided treatments for depression using deep brain stimulation. The trial targets both the subcallosal cingulate region and the ventral capsule/ventral striatum because of the different patterns of brain connections associated with each target. The trial has enrolled six patients so far, with six additional patients still to be enrolled at UT Southwestern.
Closed Loop Neuromodulation for Treatment-Refractory Schizophrenia: A Pilot Study
Bradley Lega, M.D., Associate Professor of Neurological Surgery, Neurology, and Psychiatry, and Dr. Pouratian are working with Carol Tamminga, M.D., Chair and Professor of Psychiatry, to develop a novel application of deep brain stimulation to treat schizophrenia. The goal is to use brain mapping to design custom brain stimulation patterns to guide the placement of chronic brain stimulation devices.