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TerminatedNCT03254017Updated Nov 29, 2019

Remotely Programmed Deep Brain Stimulation of the Bilateral Habenula for Treatment- Resistant Major Depression: An Open Label Pilot Trial

An interventional study of Bilateral surgical implantation of DBS system to Habeluna and Follow-up Period in Treatment Resistant Major Depressive Disorder, sponsored by Ruijin Hospital. Terminated at 2 sites in China. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2019-11-29.

Sponsored by Ruijin Hospital · Not applicable, Interventional, and Treatment

Why this study was terminated
logistics reasons
Phase
Not applicable
Study type
Interventional
Enrollment
2
Allocation
Not applicable
Ages
18 Years to 65 Years
Sex
All
01

Study summary

The habenula(Hb) is an epithalamic structure located at the center of the dorsal diencephalic conduction system, a pathway involved in linking forebrain to midbrain regions. An increasing number of studies indicates that that overactivity in the lateral habeluna(LHb) is present during depressed states, where it could drive the changes in midbrain activity linked to depression. Deep brain stimulation(DBS) of the major afferent bundle (i.e., stria medullaris thalami) of the LHb can treat treatment-resistant major depression(TRD). There is no clinical case of directly stimulating habeluna for treatment TRD. This research will investigate effectiveness bilateral DBS to habenula for patients with TRD.

Programming is a crucial aspect of DBS which directly influences its therapeutic efficacy. Researchers need to ascertain optimum stimulation parameters to help patients achieve optimal control of clinical symptoms. Remote programming of DBS can markedly improve patient convenience, minimize risk of infection and total treatment time and lead to an overall benefit for doctors and patients alike. This research will also investigate safety and benefit of remote programming of DBS.

02

Conditions studied

  • Treatment Resistant Major Depressive Disorder

Keywords

  • Bilateral Habeluna
  • Remote Deep Brain Stimulation
  • Treatment Resistant Major Depressive Disorder
03

Who can participate

Ages eligible
18 Years to 65 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Age 18-65 years old
  • Proficiency in Mandarin language;
  • DSM-IV diagnosis of Majior depression disorder;
  • Current episode duration ≥ 2 years;
  • Failure to respond to a minimum of four different antidepressant treatments;
  • Failure or intolerance of an adequate course of electroconvulsive therapy (ECT) during any episode;
  • Capacity to provide informed consent (understanding of the study purpose and methods);

Exclusion criteria

Exclusion Criteria:

  • Schizophrenia or history of psychosis unrelated to MDD;
  • Antisocial personality disorder, dementia, current tic disorder;
  • Past stereotactic neurosurgical intervention;
  • Alcohol or substance abuse/dependence within 6 months;
  • Neurological disease (Abnormal PET-CT, MRI, EEG);
  • Contraindications of MRI-examination, e.g. implanted cardiac pacemaker/ heart defibrillator;
  • Contraindications of stereotactic intervention, e.g. increased bleeding disposition, cerebrovascular diseases;
  • Serious and unstable organic diseases (e.g. unstable coronal heart disease);
  • HIV positive;
  • Pregnancy and/or lactation;
04

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
2 participants (actual)

Study arms

  • Experimental
    Experimental Deep Brain Stimulation

    Device:Suzhou Sceneray® DBS system

    Procedure: Bilateral surgical implantation of DBS system to Habeluna · Other: Follow-up Period

Interventions

  • ProcedureBilateral surgical implantation of DBS system to Habeluna

    The SceneRay DBS device utilized in the present study is a double-channel device designed and manufactured by Suzhou Scene-Ray Medical Co., Ltd. The DBS system includes a dual-channel neurostimulator kit, lead kit, extension kit, clinician-operated wireless programmer, test stimulator, and patient controller. The lead (diameter =1.27 mm) contains four stimulating contacts made of platinumiridium alloy. The length of each contact is 1.5 mm, and interval spaces are 0.5 mm. This device shares the same basic principles utilized by Medtronic products, with unique wireless programming and electrode fixing designs. The amplitude (0-10 V), pulse width (60-960 ms), and frequency (1-1,600 Hz) can be programmed, and different frequencies may be utilized in the left and right hemispheres using this type of dual-channel IPG.

  • OtherFollow-up Period

    The researchers will remotely program the DBS biweekly after opening the stimulator and face to face test the patients' cognitive function every half year. Montgomery-Asberg Depression Rating Scale will be tested biweekly until the Programmed parameter has stable therapeutic efficacy and then tested after 3 months, 6 months, 9 months and 12 months.The other neuropsychological scales will be test on 3 months, 6 months, 9 months and 12 months.

05

What researchers measure

Primary outcomes

  1. Change in the Montgomery-Asberg Depression Rating Scale

    Time frame: Baseline (preoperative),Biweekly after onset of the DBS system,3 months,6 months, 9 months, 12 months

  2. Change in the Hamilton Depression Scale

    Time frame: Baseline(preoperative),3 months, 6 months,9 months, 12months

Secondary outcomes

  1. Change in the Hamilton Anxiety Scale

    Time frame: Baseline(preoperative),3 months, 6 months,9 months, 12months

  2. Change in the Quality of Life Assessment (SF-36)

    Time frame: Baseline(preoperative),3 months, 6 months,9 months, 12 months

  3. Neuropsychological measures(Scores of cogstate battery)

    Time frame: Baseline(preoperative),6 months,12 months

  4. Change in the Hamilton Anxiety Scale

    Time frame: Baseline(preoperative),3 months, 6 months,9 months, 12 months

  5. Change in the WHO-BREF

    Time frame: Baseline(preoperative),3 months,6 months,9 months, 12 months

  6. Change in Young Manic Rating Scale

    Time frame: Baseline (preoperative),Biweekly after onset of the DBS system,3 months,6 months, 9 months, 12 months

  7. Chang in Pittsburgh Sleep Quality Index

    Time frame: Baseline(preoperative),3 months,6 months,9 months, 12 months

06

Study locations

2 sites
  • Shanghai Ruijin Hospital Functional Neurosurgery
    Shanghai, Shanghai 200025, China
  • Shanghai Ruijin Hospital Functional Neurosurgery
    Shanghai, Shanghai, China
07

References and documents

Publications

  • Sartorius A, Kiening KL, Kirsch P, von Gall CC, Haberkorn U, Unterberg AW, Henn FA, Meyer-Lindenberg A. Remission of major depression under deep brain stimulation of the lateral habenula in a therapy-refractory patient. Biol Psychiatry. 2010 Jan 15;67(2):e9-e11. doi: 10.1016/j.biopsych.2009.08.027. No abstract available. PubMed 19846068 ↗
  • Kiening K, Sartorius A. A new translational target for deep brain stimulation to treat depression. EMBO Mol Med. 2013 Aug;5(8):1151-3. doi: 10.1002/emmm.201302947. Epub 2013 Jul 4. No abstract available. PubMed 23828711 ↗
  • Fakhoury M. The habenula in psychiatric disorders: More than three decades of translational investigation. Neurosci Biobehav Rev. 2017 Dec;83:721-735. doi: 10.1016/j.neubiorev.2017.02.010. Epub 2017 Feb 13. PubMed 28223096 ↗
  • Proulx CD, Hikosaka O, Malinow R. Reward processing by the lateral habenula in normal and depressive behaviors. Nat Neurosci. 2014 Sep;17(9):1146-52. doi: 10.1038/nn.3779. PubMed 25157511 ↗
  • Bergfeld IO, Mantione M, Hoogendoorn ML, Ruhe HG, Notten P, van Laarhoven J, Visser I, Figee M, de Kwaasteniet BP, Horst F, Schene AH, van den Munckhof P, Beute G, Schuurman R, Denys D. Deep Brain Stimulation of the Ventral Anterior Limb of the Internal Capsule for Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Psychiatry. 2016 May 1;73(5):456-64. doi: 10.1001/jamapsychiatry.2016.0152. PubMed 27049915 ↗
  • Li D, Zhang C, Gault J, Wang W, Liu J, Shao M, Zhao Y, Zeljic K, Gao G, Sun B. Remotely Programmed Deep Brain Stimulation of the Bilateral Subthalamic Nucleus for the Treatment of Primary Parkinson Disease: A Randomized Controlled Trial Investigating the Safety and Efficacy of a Novel Deep Brain Stimulation System. Stereotact Funct Neurosurg. 2017;95(3):174-182. doi: 10.1159/000475765. Epub 2017 Jun 2. PubMed 28571034 ↗
  • Zhang C, Li D, Zeljic K, Tan H, Ning Y, Sun B. A Remote and Wireless Deep Brain Stimulation Programming System. Neuromodulation. 2016 Jun;19(4):437-9. doi: 10.1111/ner.12448. No abstract available. PubMed 27321195 ↗
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Registry details

Key details

Study ID
NCT03254017
Lead sponsor
Ruijin Hospital
Responsible party
Bomin Sun (Director of the Department of Functional Neurosurgery, Ruijin Hospital) — Principal investigator
First posted
Aug 18, 2017
Start date
Jul 24, 2017
Primary completion
Nov 30, 2018
Completion
Aug 30, 2019
Last update
Nov 29, 2019

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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