http://www.scientificamerican.com/video.cfm?id=new-implant-brings-high-hopes-for-b2013-04-21&WT.mc_id=SA_DD_20130423
- Posted using from my iPad HD
Location:Georgetown,United States
Tuesday, April 23, 2013
Potential new treatment for back pain
Here is a potential new treatment for back pain.
http://www.scientificamerican.com/video.cfm?id=new-implant-brings-high-hopes-for-b2013-04-21&WT.mc_id=SA_DD_20130423
- Posted using from my iPad HD
http://www.scientificamerican.com/video.cfm?id=new-implant-brings-high-hopes-for-b2013-04-21&WT.mc_id=SA_DD_20130423
- Posted using from my iPad HD
Sunday, April 21, 2013
From the Georgetown Advocate- The Tech Savvy Patient A Real Example
The Tech Savvy Patient A Real Example
The Georgetown Advocate
Webster Russell
Even in this era of rapidly changing personal technology, healthcare's customer, us, are ill informed and therefore being led to places we may not want to go. We have been led to believe that our health and the processes that impact it are just to complex for us to understand, in English we are not smart enough. Technology and the Internet has and will change all that.
Allow me to stumble back into the weeds for a moment. Neurophysiologically, intelligence is a function of neural connectivity. Placing this in non human terms, the internet is the evolving nervous system of civilization. To that end, if you are not at least minimally computer literate, you are rapidly becoming obsolete. In that sense, the ultimate power you as an individual have over any thing in the realm of your life is knowledge, and that knowledge base changes not by the day but by the minute. Knowledge is power, power is choice, and choice takes you from being a follower to being your life's leader.
Believe it or not, this segways into the earlier question, how did a priest, the Internet, and Alzheimer's create a tech savvy patient?
If you think about healthcare from an individual's stand point, you’re putting your or a loved ones life into the hands of a physician. His or her knowledge will form the basis of what you should do to change the outcome of a disease or ailment and that requires a lot of trust. To build that trust, you need to seek additional information so you can ask better questions, and therefore make better decisions. My contention is that the expansion of information via the internet combined with computer literacy may well lead to new “experts” in healthcare and other fields.
A case in point revolves around an Episcopal priest, his wife, and their physician. As fate would have it, the clergyman’s wife was diagnosed with a chronically debilitating disease, Alzheimer's. From the day of her diagnosis, using the internet, this man started an in depth investigation of his wife’s disease and the therapies used, both present and future. Within six months, he became the titular expert in the therapeutics of his wife’s disease. Up until the day he died he continued to assist her physicians by providing them with new and proposed treatment methodologies, thereby being an active participant in his wife's care. Two points to note. When this story started, in 1996, home wifi would not be commercially available for three more years. Secondly and as importantly the gentleman in question was in his mid 70s when her diagnosis was made.
Did his efforts help his wife? Let me repeat myself, Knowledge is power, power is choice, and choice takes you from being a follower to being your life's leader, and a follower he wasn't.
- Posted using from my iPad HD
The Georgetown Advocate
Webster Russell
Even in this era of rapidly changing personal technology, healthcare's customer, us, are ill informed and therefore being led to places we may not want to go. We have been led to believe that our health and the processes that impact it are just to complex for us to understand, in English we are not smart enough. Technology and the Internet has and will change all that.
Allow me to stumble back into the weeds for a moment. Neurophysiologically, intelligence is a function of neural connectivity. Placing this in non human terms, the internet is the evolving nervous system of civilization. To that end, if you are not at least minimally computer literate, you are rapidly becoming obsolete. In that sense, the ultimate power you as an individual have over any thing in the realm of your life is knowledge, and that knowledge base changes not by the day but by the minute. Knowledge is power, power is choice, and choice takes you from being a follower to being your life's leader.
Believe it or not, this segways into the earlier question, how did a priest, the Internet, and Alzheimer's create a tech savvy patient?
If you think about healthcare from an individual's stand point, you’re putting your or a loved ones life into the hands of a physician. His or her knowledge will form the basis of what you should do to change the outcome of a disease or ailment and that requires a lot of trust. To build that trust, you need to seek additional information so you can ask better questions, and therefore make better decisions. My contention is that the expansion of information via the internet combined with computer literacy may well lead to new “experts” in healthcare and other fields.
A case in point revolves around an Episcopal priest, his wife, and their physician. As fate would have it, the clergyman’s wife was diagnosed with a chronically debilitating disease, Alzheimer's. From the day of her diagnosis, using the internet, this man started an in depth investigation of his wife’s disease and the therapies used, both present and future. Within six months, he became the titular expert in the therapeutics of his wife’s disease. Up until the day he died he continued to assist her physicians by providing them with new and proposed treatment methodologies, thereby being an active participant in his wife's care. Two points to note. When this story started, in 1996, home wifi would not be commercially available for three more years. Secondly and as importantly the gentleman in question was in his mid 70s when her diagnosis was made.
Did his efforts help his wife? Let me repeat myself, Knowledge is power, power is choice, and choice takes you from being a follower to being your life's leader, and a follower he wasn't.
- Posted using from my iPad HD
Location:Georgetown TX,United States
Sunday, April 14, 2013
5 Technologies That Will Change Medicine in the Next 5 Years
5 Technologies That Will Change Medicine in the Next 5 Years
by TERA TUTEN on MARCH 12, 2013
Advances in medical technology over the past 5 years have been impressive. But even more impressive: the widespread adoption of a scant few of those technologies.
While we could list dozens of future healthcare game-changers, the picks below are five we think actually stand a chance of being adopted soon, dramatically changing the way medicine is practiced:
3D printing (prosthetics, and possibly real body parts)
Just 10 years ago, 3D printing was the stuff of just the most forward-looking science fiction views of the future. Now in widespread industry use (and even limited consumer use), 3D printers can build replacement knee joints and even prosthetic legs. But soon, 3D printers may be able to build prosthetics with biological material, including a patient’s own stem cells. By doing this, scientists can build prosthetics using biodegradable material that stem-cell-grown tissue (cartilage, etc…) can grow on top of.
Biodegradable electronic medical implants
As with 3D body part “printing”, this is another aspect of medicine where foreign implants with lifespans less than a human life, might soon be able to “uninstall” themselves by simply being absorbed into your body after a set period of time.
Researchers are working on creating electronic human implants out of super-thin circuits encased in biodegradable silk proteins.
Micro, mobile healthcare
While a number of restrictions have kept wider-spread use of mobile medical technology (especially smartphone-based) from fully flourishing in the U.S., a lot of innovation in using mobile phones for health care is happening in Africa and India. Part of the reason mobile health and telemedicine are taking off there is the relative lack of physicians in many areas of these countries.
Meanwhile, in Canada, microfluidic-based systems are allowing researchers to do clinic-level biodiagnostics with a device the size of a toaster, with results delivered in minutes, for dollars-to-pennies per test.
One example of this is Microflow, a tiny device that passes samples through a fiber-optic sheath to analyse the cause of sickness in remote communities. The Quebec-based innovation was approved for testing in orbit during 2013 on the International Space Station.
Speaking of medicine in space, there’s even a $10 million X Prize for the inventor of the first functional “tricorder” style device to drive innovation in mobile, micro healthcare forward.
A 2012 report on electronic medical records pegged U.S. spending on such systems at $18 billion – up more than 14% – a significant increase from the previous year. Good news, as two similarly-recent U.S. studies noted that “computerised physician order entry” reduced error rates by 55% and 88% for rates of serious medication errors. A separate study demonstrated a 70% reduction in antibiotic-related avoidable drug errors.
NASA’s real-life “Ironman” suit could be the standard for limb rehabilitation
The Florida Institute for Human and Machine Cognition (IHMC) and NASA are looking to use their X1 exoskeleton suit as an assistive walking device.
By combining the technology and complex walking algorithms, the suit has the potential to produce high enough torques to allow patients with limb degeneration or damage to get help walking over a variety of terrain, and possibly even up stairs.
- Posted using from my iPad HD
by TERA TUTEN on MARCH 12, 2013
Advances in medical technology over the past 5 years have been impressive. But even more impressive: the widespread adoption of a scant few of those technologies.
While we could list dozens of future healthcare game-changers, the picks below are five we think actually stand a chance of being adopted soon, dramatically changing the way medicine is practiced:
3D printing (prosthetics, and possibly real body parts)
Just 10 years ago, 3D printing was the stuff of just the most forward-looking science fiction views of the future. Now in widespread industry use (and even limited consumer use), 3D printers can build replacement knee joints and even prosthetic legs. But soon, 3D printers may be able to build prosthetics with biological material, including a patient’s own stem cells. By doing this, scientists can build prosthetics using biodegradable material that stem-cell-grown tissue (cartilage, etc…) can grow on top of.
Biodegradable electronic medical implants
As with 3D body part “printing”, this is another aspect of medicine where foreign implants with lifespans less than a human life, might soon be able to “uninstall” themselves by simply being absorbed into your body after a set period of time.
Researchers are working on creating electronic human implants out of super-thin circuits encased in biodegradable silk proteins.
Micro, mobile healthcare
While a number of restrictions have kept wider-spread use of mobile medical technology (especially smartphone-based) from fully flourishing in the U.S., a lot of innovation in using mobile phones for health care is happening in Africa and India. Part of the reason mobile health and telemedicine are taking off there is the relative lack of physicians in many areas of these countries.
Meanwhile, in Canada, microfluidic-based systems are allowing researchers to do clinic-level biodiagnostics with a device the size of a toaster, with results delivered in minutes, for dollars-to-pennies per test.
One example of this is Microflow, a tiny device that passes samples through a fiber-optic sheath to analyse the cause of sickness in remote communities. The Quebec-based innovation was approved for testing in orbit during 2013 on the International Space Station.
Speaking of medicine in space, there’s even a $10 million X Prize for the inventor of the first functional “tricorder” style device to drive innovation in mobile, micro healthcare forward.
A 2012 report on electronic medical records pegged U.S. spending on such systems at $18 billion – up more than 14% – a significant increase from the previous year. Good news, as two similarly-recent U.S. studies noted that “computerised physician order entry” reduced error rates by 55% and 88% for rates of serious medication errors. A separate study demonstrated a 70% reduction in antibiotic-related avoidable drug errors.
NASA’s real-life “Ironman” suit could be the standard for limb rehabilitation
The Florida Institute for Human and Machine Cognition (IHMC) and NASA are looking to use their X1 exoskeleton suit as an assistive walking device.
By combining the technology and complex walking algorithms, the suit has the potential to produce high enough torques to allow patients with limb degeneration or damage to get help walking over a variety of terrain, and possibly even up stairs.
- Posted using from my iPad HD
Location:Georgetown TX, United States
Friday, April 5, 2013
Labor and spicy food
The Wall Street Journal by ANN LUKITS
• Labor and spicy food: Some women eat spicy foods at the end of pregnancy, hoping it will bring on labor, though there is no scientific proof that it works. But a pilot study published in the journal Anesthesiology suggests that applying an extract of red chili peppers called capsaicin directly to the cervix may help shorten the time to delivery and reduce the pain of laboring.
Experiments at Columbia University were conducted on four groups of pregnant mice three days before they were due to deliver.
Two groups received either a low or high dose of morphine by injection, plus lidocaine applied to the cervix.
One group received saline injections, plus cervical lidocaine and 0.1% capsaicin cream. Lidocaine was used to limit any acute discomfort related to capsaicin, researchers said. A control group received a saline solution and lidocaine.
The mice were videotaped during labor and four behaviors associated with labor pain in rodents were assessed. Both capsaicin and morphine significantly reduced the incidence of all four pain-related behaviors compared with controls, the results showed.
On average, laboring mice treated with high and low doses of morphine exhibited 34.6 and 46.4 pain behaviors per hour respectively while 38.9 behaviors were recorded per hour in capsaicin-treated mice. Pain behaviors in control mice averaged 55 per hour.
Capsaicin-treated mice delivered each pup in under 15 minutes, compared with over 16 minutes in controls. Capsaicin had no negative effects on the offspring.
Capsaicin may desensitize pain receptors on the cervix and trigger the release of protein-like molecules that orchestrate a series of biological events that lead to the start of labor, researchers said.
Caveat: The optimum dose of capsaicin isn’t known, researchers said. The research hasn’t been tested on pregnant women.
- Posted using from my iPad HD
• Labor and spicy food: Some women eat spicy foods at the end of pregnancy, hoping it will bring on labor, though there is no scientific proof that it works. But a pilot study published in the journal Anesthesiology suggests that applying an extract of red chili peppers called capsaicin directly to the cervix may help shorten the time to delivery and reduce the pain of laboring.
Experiments at Columbia University were conducted on four groups of pregnant mice three days before they were due to deliver.
Two groups received either a low or high dose of morphine by injection, plus lidocaine applied to the cervix.
One group received saline injections, plus cervical lidocaine and 0.1% capsaicin cream. Lidocaine was used to limit any acute discomfort related to capsaicin, researchers said. A control group received a saline solution and lidocaine.
The mice were videotaped during labor and four behaviors associated with labor pain in rodents were assessed. Both capsaicin and morphine significantly reduced the incidence of all four pain-related behaviors compared with controls, the results showed.
On average, laboring mice treated with high and low doses of morphine exhibited 34.6 and 46.4 pain behaviors per hour respectively while 38.9 behaviors were recorded per hour in capsaicin-treated mice. Pain behaviors in control mice averaged 55 per hour.
Capsaicin-treated mice delivered each pup in under 15 minutes, compared with over 16 minutes in controls. Capsaicin had no negative effects on the offspring.
Capsaicin may desensitize pain receptors on the cervix and trigger the release of protein-like molecules that orchestrate a series of biological events that lead to the start of labor, researchers said.
Caveat: The optimum dose of capsaicin isn’t known, researchers said. The research hasn’t been tested on pregnant women.
- Posted using from my iPad HD
Location:Georgetown, TX,United States
Thursday, March 21, 2013
How to Treat Burns With Running Water
The Research Report: How to Treat Burns With Running Water - WSJ.com
The Wall Street Journal by ANN LUKITS
Running cold tap water over accidental burns and scalds is generally accepted as the best way to cool the skin and prevent blistering. But a study in the Journal of Plastic, Reconstructive & Aesthetic Surgery suggests the reverse—that using warm instead of cold water, while counterintuitive, may be a more effective method of limiting tissue damage and restoring blood flow to burned areas.
Swiss researchers used a heated metal template to induce same-size burns on anesthetized rats in four places on each of their backs. (Pain medication was administered before and after the procedure.)
One group of rats was treated for 20 minutes with gauze soaked in water cooled to 62.6 degrees Fahrenheit. A second group received gauze containing water at 98.6 degrees.
A third group of control rats wasn’t treated. The burns and unburned spaces between the burns were tested after one hour, 24 hours, four days and seven days.
Within 24 hours, burn damage in the control rats had extended to underlying tissues, whereas the burned area didn’t immediately change in the rats treated with cold or warm water, researchers said. After four days, all the animals developed tissue damage, or necrosis, in the spaces between the burns, but the damage was significantly less in the rats treated with warm water.
Necrosis affected 65% of interspaces in warm-water rats, 81% in cold-water rats and 94% in controls. Normal blood flow, assessed with a laser probe, was only restored in warm-water rats.
Although the experiments were performed on rats, the researchers said the basic principles and mechanisms of burn progression are similar to those in humans.
While applying cold tap water to burns helps to cool the skin, it can be painful after 20 minutes and leads to abnormally low temperature in the skin, according to lead researcher Reto Wettstein, a plastic and reconstructive hand surgeon in Basel, Switzerland. Dr. Wettstein personally practices rapid cooling with cold water for about a minute and then switches to warm water to help restore circulation.
Caveat: The findings only apply to second-degree burns that don’t require surgery, researchers said. The study didn’t consider other complications associated with burns, such as shock and the potential for hypothermia.
- Posted using from my iPad HD
The Wall Street Journal by ANN LUKITS
Running cold tap water over accidental burns and scalds is generally accepted as the best way to cool the skin and prevent blistering. But a study in the Journal of Plastic, Reconstructive & Aesthetic Surgery suggests the reverse—that using warm instead of cold water, while counterintuitive, may be a more effective method of limiting tissue damage and restoring blood flow to burned areas.
Swiss researchers used a heated metal template to induce same-size burns on anesthetized rats in four places on each of their backs. (Pain medication was administered before and after the procedure.)
One group of rats was treated for 20 minutes with gauze soaked in water cooled to 62.6 degrees Fahrenheit. A second group received gauze containing water at 98.6 degrees.
A third group of control rats wasn’t treated. The burns and unburned spaces between the burns were tested after one hour, 24 hours, four days and seven days.
Within 24 hours, burn damage in the control rats had extended to underlying tissues, whereas the burned area didn’t immediately change in the rats treated with cold or warm water, researchers said. After four days, all the animals developed tissue damage, or necrosis, in the spaces between the burns, but the damage was significantly less in the rats treated with warm water.
Necrosis affected 65% of interspaces in warm-water rats, 81% in cold-water rats and 94% in controls. Normal blood flow, assessed with a laser probe, was only restored in warm-water rats.
Although the experiments were performed on rats, the researchers said the basic principles and mechanisms of burn progression are similar to those in humans.
While applying cold tap water to burns helps to cool the skin, it can be painful after 20 minutes and leads to abnormally low temperature in the skin, according to lead researcher Reto Wettstein, a plastic and reconstructive hand surgeon in Basel, Switzerland. Dr. Wettstein personally practices rapid cooling with cold water for about a minute and then switches to warm water to help restore circulation.
Caveat: The findings only apply to second-degree burns that don’t require surgery, researchers said. The study didn’t consider other complications associated with burns, such as shock and the potential for hypothermia.
- Posted using from my iPad HD
Location:Vail Ct,Georgetown,United States
Saturday, March 16, 2013
That bright screen can keep you up at night
Bright Screens Could Delay Bedtime
Using a tablet or computer in the late evening disrupts the body's melatonin production
By Stephani Sutherland
If you have trouble sleeping, laptop or tablet use at bedtime might be to blame, new research suggests. Mariana Figueiro of the Lighting Research Center at Rensselaer Polytechnic Institute and her team showed that two hours of iPad use at maximum brightness was enough to suppress people's normal nighttime release of melatonin, a key hormone in the body's clock, or circadian system. Melatonin tells your body that it is night, helping to make you sleepy. If you delay that signal, Figueiro says, you could delay sleep. Other research indicates that “if you do that chronically, for many years, it can lead to disruption of the circadian system,” sometimes with serious health consequences, she explains.
The dose of light is important, Figueiro says; the brightness and exposure time, as well as the wavelength, determine whether it affects melatonin. Light in the blue-and-white range emitted by today's tablets can do the trick—as can laptops and desktop computers, which emit even more of the disrupting light but are usually positioned farther from the eyes, which ameliorates the light's effects. The team designed light-detector goggles and had subjects wear them during late-evening tablet use. The light dose measurements from the goggles correlated with hampered melatonin production.
On the bright side, a morning shot of screen time could be used as light therapy for seasonal affective disorder and other light-based problems. Figueiro hopes manufacturers will “get creative” with tomorrow's tablets, making them more “circadian friendly,” perhaps even switching to white text on a black screen at night to minimize the light dose. Until then, do your sleep schedule a favor and turn down the brightness of your glowing screens before bed—or switch back to good old-fashioned books.
- Posted using from my iPad HD
Using a tablet or computer in the late evening disrupts the body's melatonin production
By Stephani Sutherland
If you have trouble sleeping, laptop or tablet use at bedtime might be to blame, new research suggests. Mariana Figueiro of the Lighting Research Center at Rensselaer Polytechnic Institute and her team showed that two hours of iPad use at maximum brightness was enough to suppress people's normal nighttime release of melatonin, a key hormone in the body's clock, or circadian system. Melatonin tells your body that it is night, helping to make you sleepy. If you delay that signal, Figueiro says, you could delay sleep. Other research indicates that “if you do that chronically, for many years, it can lead to disruption of the circadian system,” sometimes with serious health consequences, she explains.
The dose of light is important, Figueiro says; the brightness and exposure time, as well as the wavelength, determine whether it affects melatonin. Light in the blue-and-white range emitted by today's tablets can do the trick—as can laptops and desktop computers, which emit even more of the disrupting light but are usually positioned farther from the eyes, which ameliorates the light's effects. The team designed light-detector goggles and had subjects wear them during late-evening tablet use. The light dose measurements from the goggles correlated with hampered melatonin production.
On the bright side, a morning shot of screen time could be used as light therapy for seasonal affective disorder and other light-based problems. Figueiro hopes manufacturers will “get creative” with tomorrow's tablets, making them more “circadian friendly,” perhaps even switching to white text on a black screen at night to minimize the light dose. Until then, do your sleep schedule a favor and turn down the brightness of your glowing screens before bed—or switch back to good old-fashioned books.
- Posted using from my iPad HD
Location:Georgetown, TX
Wednesday, March 13, 2013
A little zap to the brain may ease depression
A Little Juice to the Brain Eases Depression
medpagetoday.com by Crystal Phend on February 6, 2013
By Crystal Phend, Senior Staff Writer, MedPage Today
Published: February 06, 2013
Non-invasive, electric stimulation of the brain appears to help the initial phase of treatment in major depressive disorder, especially in combination with an antidepressant, a double-blind trial showed.
Six weeks of daily transcranial direct current stimulation sessions reduced depression scores roughly the same as sertraline (Zoloft, P=0.35), Andre R. Brunoni, MD, PhD, of the University of São Paulo, Brazil, and colleagues reported online in JAMA Psychiatry.
The two together brought scores down by an average 8.5 points more than sertraline alone on a depression rating scale, and by 5.9 points more than direct current stimulation alone (P=0.002 and P=0.03, respectively).
A 3-point difference on that Montgomery-Asberg Depression Rating Scale (MADRS) is considered clinically relevant.
“Noninvasive brain stimulation is becoming an established therapy for the treatment of depression,” Brunoni and colleagues wrote.
The weak electrical current applied across large electrodes on the scalp may work by boosting activity in an area of the brain known to be hypoactive in depression, with the advantage of not having the same adverse effects and contraindications as antidepressant drugs, the group pointed out.
The device also is relatively inexpensive, so it might be a “cost-effective alternative for regions with low resources where the prevalence of major depressive disorder is high, such as most developing nations,” they added.
However, the treatment is less practical than taking a pill, and it’s not clear how its results would hold up in the maintenance phase.
“Even if transcranial direct current stimulation becomes available for in-house use, it would still require 20- to 30-minute daily sessions for several weeks,” Brunoni’s group wrote.
Their Sertraline vs Electrical Current Therapy for Treating Depression Clinical Study (SELECT TDCS) compared in a two-by-two design treatment with 6 weeks of sertraline at 50 mg per day or placebo and 2-mA anodal left/cathodal right prefrontal transcranial direct current stimulation (30-minute sessions each weekday plus two extra sessions every other week) or sham.
It included 120 antidepressant-naive patients with moderate-to-severe major depressive disorder but no psychotic or bipolar component, seen at a single outpatient center in an academic setting in São Paulo. The cohort had a relatively low degree of refractoriness and short duration of the index episode.
The only thing that wasn’t better than inactive treatment at the end of the 6-week period was sertraline alone, with a mean difference of 2.9 points versus placebo (P=0.20).
The explanation may have been that 50 mg per day was a low dose for some participants, though there have been negative trials with sertraline in major depressive disorder, the researchers pointed out.
Transcranial direct current stimulation improved MADRS score by 5.6 points over sham (P=0.01).
The combination of the two appeared to work fastest, as that was the only group with a significant change in score at week two. Factorial analysis suggested that the initial effect was driven primarily by the electric stimulation treatment.
The two appeared to be additive rather than synergistic.
Clinical response with at least a 50% reduction in baseline MADRS score was significantly more common with transcranial direct current stimulation or combination treatment than with placebo (43% and 63% versus 17%).
Remission, with MADRS score falling to 10 points or less, occurred in 47% of the combo group and 40% of the electrical stimulation group, which were both significantly better than the 13% rate with placebo.
Sertraline alone induced remission in 30%, although this difference didn’t reach significance.
No negative cognitive effects were seen with transcranial direct current stimulation, though skin redness was more common at the end of week two.
Of the seven episodes of treatment-emergent mania or hypomania, five were in the combined treatment group, including one severe manic episode requiring pharmacologic intervention.
Mania or hypomania induction may be similar with transcranial direct current stimulation as with antidepressants, so such events need careful monitoring in future trials, Brunoni’s group noted.
Further research is needed into longer-term effects and into use in the inpatient setting, they added.
Their trial includes an open-label phase for sham nonresponders to cross over to 10 days of active transcranial direct current stimulation, as well as a 6-month follow-up phase for those who responded to active treatment in the first 6 weeks.
The study was funded by a grant from the São Paulo Research Foundation.
The researchers reported having no conflicts of interest to disclose.
medpagetoday.com by Crystal Phend on February 6, 2013 • Report a text problem
◆
- Posted using from my iPad HD
medpagetoday.com by Crystal Phend on February 6, 2013
By Crystal Phend, Senior Staff Writer, MedPage Today
Published: February 06, 2013
Non-invasive, electric stimulation of the brain appears to help the initial phase of treatment in major depressive disorder, especially in combination with an antidepressant, a double-blind trial showed.
Six weeks of daily transcranial direct current stimulation sessions reduced depression scores roughly the same as sertraline (Zoloft, P=0.35), Andre R. Brunoni, MD, PhD, of the University of São Paulo, Brazil, and colleagues reported online in JAMA Psychiatry.
The two together brought scores down by an average 8.5 points more than sertraline alone on a depression rating scale, and by 5.9 points more than direct current stimulation alone (P=0.002 and P=0.03, respectively).
A 3-point difference on that Montgomery-Asberg Depression Rating Scale (MADRS) is considered clinically relevant.
“Noninvasive brain stimulation is becoming an established therapy for the treatment of depression,” Brunoni and colleagues wrote.
The weak electrical current applied across large electrodes on the scalp may work by boosting activity in an area of the brain known to be hypoactive in depression, with the advantage of not having the same adverse effects and contraindications as antidepressant drugs, the group pointed out.
The device also is relatively inexpensive, so it might be a “cost-effective alternative for regions with low resources where the prevalence of major depressive disorder is high, such as most developing nations,” they added.
However, the treatment is less practical than taking a pill, and it’s not clear how its results would hold up in the maintenance phase.
“Even if transcranial direct current stimulation becomes available for in-house use, it would still require 20- to 30-minute daily sessions for several weeks,” Brunoni’s group wrote.
Their Sertraline vs Electrical Current Therapy for Treating Depression Clinical Study (SELECT TDCS) compared in a two-by-two design treatment with 6 weeks of sertraline at 50 mg per day or placebo and 2-mA anodal left/cathodal right prefrontal transcranial direct current stimulation (30-minute sessions each weekday plus two extra sessions every other week) or sham.
It included 120 antidepressant-naive patients with moderate-to-severe major depressive disorder but no psychotic or bipolar component, seen at a single outpatient center in an academic setting in São Paulo. The cohort had a relatively low degree of refractoriness and short duration of the index episode.
The only thing that wasn’t better than inactive treatment at the end of the 6-week period was sertraline alone, with a mean difference of 2.9 points versus placebo (P=0.20).
The explanation may have been that 50 mg per day was a low dose for some participants, though there have been negative trials with sertraline in major depressive disorder, the researchers pointed out.
Transcranial direct current stimulation improved MADRS score by 5.6 points over sham (P=0.01).
The combination of the two appeared to work fastest, as that was the only group with a significant change in score at week two. Factorial analysis suggested that the initial effect was driven primarily by the electric stimulation treatment.
The two appeared to be additive rather than synergistic.
Clinical response with at least a 50% reduction in baseline MADRS score was significantly more common with transcranial direct current stimulation or combination treatment than with placebo (43% and 63% versus 17%).
Remission, with MADRS score falling to 10 points or less, occurred in 47% of the combo group and 40% of the electrical stimulation group, which were both significantly better than the 13% rate with placebo.
Sertraline alone induced remission in 30%, although this difference didn’t reach significance.
No negative cognitive effects were seen with transcranial direct current stimulation, though skin redness was more common at the end of week two.
Of the seven episodes of treatment-emergent mania or hypomania, five were in the combined treatment group, including one severe manic episode requiring pharmacologic intervention.
Mania or hypomania induction may be similar with transcranial direct current stimulation as with antidepressants, so such events need careful monitoring in future trials, Brunoni’s group noted.
Further research is needed into longer-term effects and into use in the inpatient setting, they added.
Their trial includes an open-label phase for sham nonresponders to cross over to 10 days of active transcranial direct current stimulation, as well as a 6-month follow-up phase for those who responded to active treatment in the first 6 weeks.
The study was funded by a grant from the São Paulo Research Foundation.
The researchers reported having no conflicts of interest to disclose.
medpagetoday.com by Crystal Phend on February 6, 2013 • Report a text problem
◆
- Posted using from my iPad HD
Location:Georgetown,TX
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