DBS for depression

My comment:

Although these results concerning area 25 DBS are truly encouraging, the fact that some patients do not seem to respond at all should make us wonder about a better search for more robust prediction and selection criteria. The problem is that once the electrodes are in place in the brain we cannot go back to ECT or rTMS (rapid transcranial magnetic stimulation). Although the first results of this rTMS procedure were not always consistently positive recent studies have shown that misalignment of the magnetic coil could often (40% errors) be held responsible for part of the outcome variance and this could be vastly improved pure technically by coupling the "old" rTMS stimulator to a genuine neuronavigation system cfr ANT EEG systems (http://www.ant-neuro.com/products/visor/) and even to a robot guided stimulation system. This makes it indeed more expensive but provides a much better stimulation robustness and quality especially in repetitive therapeutic stimulations. Pilot studies (fi at Univ Ulm, Germany ) have indeed shown very promising results in therapy resistent depression ! These results were presented in jan 2008 at the Neuromeeting Beaune France and will no doubt be further explored. Let us not forget that rTMS is a non invasive and non traumatic method in contrast to DBS that will always be limited to a small number of patients. As both the numbers of depressed patients and therapy resistent patients are huge, DBS will never be able to help them all.

PS A nice review on rTMS was published in Nature( Nature Reviews Neuroscience 8, (01 Oct 2007), doi: 10.1038/nrn2169-c2). So lets us help and support the DBS community but especially promote more vigorously the deployment of cornerstone studies on the therapeutic potency of the new ataumatic rTMS initiative especially in its new form that is in combination with robotica and neuronavigation.

Dr. G. Otte