Feasibility, safety, and preliminary efficacy of Low Amplitude Seizure Therapy (LAP-ST): A proof of concept clinical trial in man

Youssef, Nagy A.; Sidhom, Emad

doi:10.1016/j.jad.2017.06.022

Cited by 20 publications

(14 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The cognitive profile of magnetic seizure therapy appears promising, but the clinical efficacy of FEAST and magnetic seizure therapy has yet to be established in bipolar disorder (Cretaz et al 2015). Other efforts to improve the focality of stimulated brain volume include low amplitude seizure therapy (Radman and Lisanby 2017; Youssef and Sidhom 2017), which has yet to be thoroughly investigated with bipolar disorder. Computer modeling of the ECT induced electric field has promised even more focal methods of stimulation with reduced electrode placement size and diminished distance between stimulation electrodes (Deng et al 2013).…”

Section: Discussionmentioning

confidence: 99%

Electroconvulsive therapy electrode placement for bipolar state-related targeted engagement

Abbott

Miller

Lloyd

et al. 2019

Int J Bipolar Disord

View full text Add to dashboard Cite

Background Electroconvulsive therapy (ECT) is an effective treatment for all bipolar states. However, ECT remains underutilized, likely stemming from stigma and the risk of neurocognitive impairment. Neuroimaging research has identified state-specific areas of aberrant brain activity that may serve as targets for therapeutic brain stimulation. Electrode placement determines the geometry of the electric field and can be either non-focal (bitemporal) or more focal (right unilateral or bifrontal). Previous research has shown that electrode placement can impact clinical and cognitive outcomes independent of seizure activity. This review critically examines the evidence that focal (unilateral or bifrontal) electrode placements target specific aberrant circuitry in specific bipolar states to optimize clinical outcomes. We hypothesize that optimal target engagement for a bipolar state will be associated with equivalent efficacy relative to bitemporal non-focal stimulation with less neurocognitive impairment. Methods We performed a literature search in the PubMed database. Inclusion criteria included prospective, longitudinal investigations during the ECT series with specific electrode placements within a bipolar state from 2000 to 2018. Results We identified investigations that met our inclusion criteria with bipolar mania (n = 6), depression (n = 6), mixed (n = 3) and catatonia (n = 1) states. These studies included clinical outcomes and several included cognitive outcomes, which were discussed separately. Conclusions While the heterogeneity of the studies makes comparisons difficult, important patterns included the reduced cognitive side effects, faster rate of response, and equivalent efficacy rates of the focal electrode placements (right unilateral and bifrontal) when compared to non-focal (bitemporal) placement. Further avenues for research include more robust cognitive assessments to separate procedure-related and state-related impairment. In addition, future studies could investigate novel electrode configurations with more specific target engagement for different bipolar states.

show abstract

Section: Discussionmentioning

confidence: 99%

Electroconvulsive therapy electrode placement for bipolar state-related targeted engagement

Abbott

Miller

Lloyd

et al. 2019

Int J Bipolar Disord

View full text Add to dashboard Cite

show abstract

“…Fortunately, evidence from our prior precision LAP-ST (pLAP-ST) proof of concept open-label study has provided initial evidence of the advantage of LAP-ST in terms of cognitive side effects in humans [17]. After initial pilot titrations in the current domain to find the most appropriate range and titration combinations for the proof of concept study [18], we proceeded with enrollment for the pLAP-ST study in 2013 where we did titration in the current domain that ranged from 500mA to a maximum of 600mA.…”

Section: Introductionmentioning

confidence: 99%

Magnitude of Reduction and Speed of Remission of Suicidality for Low Amplitude Seizure Therapy (LAP-ST) Compared to Standard Right Unilateral Electroconvulsive Therapy: A Pilot Double-Blinded Randomized Clinical Trial

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: Although treatment guidelines support use of electroconvulsive therapy (ECT) for acute suicidality, it is associated with cognitive side effects. The effect of Low Amplitude Seizure Therapy (LAP-ST) on suicidality is unknown. Our prior precision LAP-ST (pLAP-ST) performing titrating in the current domain has provided initial proof of concept data in humans of its advantage in terms of reduction of cognitive side effects. The aims of this report are to: 1) compare LAP-ST (at 500mA) versus standard Right Unilateral (RUL) ECT (at 900 mA) in terms of magnitude of remission of suicidality in a randomized allocation and 2) compare the speed of remission of suicidality between LAP-ST versus RUL ECT. Methods: Patients were randomized to either LAP-ST or RUL ECT. The scores pertaining to the suicidal ideation (SI) item on the Montgomery-Åsberg Depression Rating Scale (MADRS) were analyzed using descriptive analysis and no confirmatory statistical analysis was performed due to a priori sample size limitations for this pilot study. SI item remission was defined as 2 or below on this item. Results: Eleven patients with major depressive episode (MDE) of mainly unipolar or bipolar disorders signed consent. Of these, 7 were eligible and were randomized and included in the analysis; all were actively suicidal at baseline (suicide item above 2), except 1 patient who had suicide item at 2 in the RUL ECT group. Suicidality remitted on average by session 3 and remission occurred for all patients by session 4. The SI mean score improvement from baseline to endpoint for LAP-ST was 5.1 and for RUL ECT was 3.0. Conclusions: LAP-ST has larger effect size and speed of remission of suicidality compared to standard RUL ECT. Future studies are warranted for replicating these findings. (ClinicalTrials.gov ID: NCT02583490).

show abstract

“…Andrew Ratanatharathorn 1 *, Marco P Boks 2 *, Adam X Maihofer 3,4 , Allison E Aiello 5 , Ananda B Amstadter 6 , Allison E Ashley-Koch 7 , Dewleen G Baker 3,4 , Jean C Beckham 8,9,10…”

Section: Epigenome-wide Association Of Ptsd From Heterogeneous Cohortmentioning

confidence: 99%

“…The definition of ACEs has been described previously (Su et al, 2015). The ACE score (the number of 10 ACE subscales reported) was used to assess the cumulative effect of multiple ACEs, by classifying respondents into four groups: no exposure (0 ACEs, N=126), mild (1-2 ACEs, N=157), moderate (3)(4) ACEs, N=75) and severe (≥5 ACEs, N=55) exposure.…”

Section: Assessment Of Adverse Childhood Experiencesmentioning

confidence: 99%

“…Overall, the prevalence of any ACE event is relatively higher in AAs than that in EAs (73.3% versus 65.1%, p=0.07). In summary, 69.5% of respondents reported at least one exposure to ACEs, with mild (1-2 ACEs), moderate (3)(4), and severe (≥5 ACEs) exposure to ACEs representing 38.0%, 18.2% and 13.3%, respectively ( Table 2). The prevalence of ACE scores was not significantly different between men and women, although men showed a higher rate of severe exposure to ACEs than women (16.6% versus 10.4%).…”

Section: Prevalence Of Acesmentioning

confidence: 99%

See 1 more Smart Citation

Epigenetics, resilience and brain stimulation

Adel¹

View full text Add to dashboard Cite

show abstract

Feasibility, safety, and preliminary efficacy of Low Amplitude Seizure Therapy (LAP-ST): A proof of concept clinical trial in man

Cited by 20 publications

References 37 publications

Electroconvulsive therapy electrode placement for bipolar state-related targeted engagement

Electroconvulsive therapy electrode placement for bipolar state-related targeted engagement

Magnitude of Reduction and Speed of Remission of Suicidality for Low Amplitude Seizure Therapy (LAP-ST) Compared to Standard Right Unilateral Electroconvulsive Therapy: A Pilot Double-Blinded Randomized Clinical Trial

Epigenetics, resilience and brain stimulation

Contact Info

Product

Resources

About