- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04099342
Enhanced Spatial Targeting in ECT Utilizing FEAST
Enhanced Spatial Targeting in ECT Utilizing Focally Electrically-administered Seizure Therapy (FEAST)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Design: This study will focus on refining FEAST methods by implementing a fixed-current titration and dosing method (800mA; 0.3 ms), testing the optimal directionality of current flow, and confirming specificity of induction of seizures in right orbitofrontal cortex. Twenty patients in an episode of major depression will be enrolled in the initial open-label study. Patients are kept on current medications for at least 2 weeks prior to initiation of therapy and throughout the treatment course. Patients are allowed PRN lorazepam limited to 3 mg/d but not within 10 hours of a FEAST session. Patients will undergo routine clinical care pre-ECT evaluations which include chemistry laboratory tests and an EKG. Patients will also undergo a brain MRI needed for 3D finite element modeling (FEM) to compute individual electric fields for each participant enrolled as well as an optional follow up MRI after treatment.
Once treatment is initiated, patients receive a dose 6 times initial Seizure Threshold (ST) at all treatments except the first and second, where ST is determined. If insufficient improvement (<40% change from baseline Hamilton Rating Scale for Depression, HRSD-24 item, or IDS-SR) after six treatments, the dose will increase by 50% in charge (9 times initial ST). Patients will undergo 6 channel EEG during all treatments. Participants will be randomized to FEAST (with typical electrodes placement and current flow directionality configurations) or Reverse Polarity FEAST to allow a direct comparison of induced seizure focality.
The primary measure right frontal to motor connectivity (seizure drive) and time for orientation recovery obtained following these sessions will permit direct comparison between normal configuration and RP FEAST as well. Preliminary data generated by the investigators suggest that RP polarity FEAST will elicit the most focal seizure with the shortest time for reorientation and fewest amnestic side effects.
Study Procedures:
A baseline appointment, scheduled at the Treatment Resistant Depression Clinic in Saint Louis Park, will be initially scheduled with potential participants to complete the informed consent process as well as baseline assessments for cognition, mood and quality of life. Participants will also undergo a baseline MRI that will consist of individual T1- and T2-weighted MRI scans which will be acquired with isotropic voxel resolution of 0.8 mm through resources located in the MIDB building. These structural data will be processed in the SimNIBS software to create a 3D volume conductor model of the subject's head. These MRI images will be constructed into 3D FEM models to compute non-invasive brain stimulation and electric fields for each participant enrolled.
All FEAST clinical procedures performed through Fairview will be documented in EPIC and duplicated in the research team's RedCap database for later analysis. Treatments are given in the morning, 3 times per week. Pharmacological agents are standardized: atropine (0.4 mg IV), methohexital (0.75 mg/kg) and succinylcholine (0.75-1.0 mg/kg). [If methohexital is unavailable, thiopental will be substituted (2.0 mg/kg]. Patients are oxygenated by mask (100% O2) prior to anesthesia and until resumption of spontaneous respiration. Standardized procedures are used to reduce impedance at ECT and EEG electrode sites. The d'Elia unilateral placement is used for conventional RUL ECT. FEAST will involve the 1.25" circular anterior electrode being centered at the measured FP2 position by the 10/20 EEG system, with the posterior cathode electrode (1"x2.5") tangential to the mid-sagittal plain and centered at vertex. FEAST is delivered with a modified MECTA Spectrum 5000Q relative to the commercial device with the capacity for unidirectional stimulation.
Follow up appointments after the 6th and 12th FEAST treatments (each within 1-2 days), as well as after the 15th session, if applicable, will also be conducted. They will include assessments of cognition, mood and quality of life. An optional follow up MRI may also be conducted.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Ziad Nahas, MD
- Phone Number: 952-525-4505
- Email: znahas@umn.edu
Study Contact Backup
- Name: Rachel Johnson, PhD
- Phone Number: 952-525-4505
- Email: ipl@umn.edu
Study Locations
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-
Minnesota
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Minneapolis, Minnesota, United States, 55455
- Recruiting
- University of Minnesota
-
Contact:
- Ziad Nahas, MSCR
- Phone Number: 952-525-4505
- Email: znahas@umn.edu
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Diagnosis of major depressive disorder using mini-7 to derive RDC; DSM-IV
- Pretreatment HRSD score greater than or equal to 18
- ECT indicated by physician evaluation
- Willing and capable of providing informed consent as determined by physician evaluation
Exclusion Criteria:
- History of schizophrenia, schizoaffective disorder, other functional psychosis, or rapid cycling bipolar disorder as determined by mini-7; rapid cycling defined as greater than or equal to four episodes in past year
- History of neurological illness or insult other than conditions associated with psychotropic exposure (e.g., tardive dyskinesia) determined by physician evaluation and medical history
- Alcohol or substance abuse or dependence in the past year (RDC) determined by physician evaluation
- Secondary diagnosis of a delirium, dementia, or amnestic disorder (DSM-IV), pregnancy, or epilepsy determined by physician evaluation
- Requires especially rapid antidepressant response due to suicidality, psychosis, inanition, psychosocial obligations, etc. determined by physician evaluation
- ECT in the past six months determined by physician evaluation and medical history
- Pregnancy as determined by urine pregnancy test and clinical interview
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: A: FEAST
Focally Electrically-administered Seizure Therapy (FEAST) is a form of Electroconvulsive therapy (ECT) that combines unidirectional stimulation, control of polarity, and an asymmetrical electrode configuration.
|
FEAST with standard electrode configuration and current flow
FEAST with standard electrode configuration and reversed current flow
|
Experimental: B: RP FEAST
Focally Electrically-administered Seizure Therapy (FEAST) with Reversed Polarity (RP) utilizes the same electrode placement as FEAST but a reversed directionality of current flow.
|
FEAST with standard electrode configuration and current flow
FEAST with standard electrode configuration and reversed current flow
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Seizure Drive Markers on EEG
Time Frame: 8 weeks
|
Electrophysiological markers of the induced seizure will be captured with a 6-lead EEG placed over bilateral frontal, temporal and parietal lobes.
Raw data will be collected in MicroVolts while the analysis will summarize connectivity measures.
Right prefrontal activity and seizure drive will be contrasted to other regions from which EEG is recorded, to describe the focality of FEAST-induced seizures.
|
8 weeks
|
Seizure characteristics on EEG
Time Frame: 8 weeks
|
Length of induced seizures is measured by EEG and recorded in seconds.
Spectra powers, global and regional intensity will also be analyzed.
|
8 weeks
|
Seizure characteristics by motor observation
Time Frame: 8 weeks
|
Length of induced seizures is measured by motor observation and recorded in seconds.
Spectra powers, global and regional intensity will also be analyzed.
|
8 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Time to Reorientation
Time Frame: 8 weeks
|
Time between subject open eyes immediately after procedure and correctly identifying 4 out of 5 questions on orientation to name, time and space will be noted in seconds.
|
8 weeks
|
Amnestic Side Effects
Time Frame: 8 weeks
|
Amnestic side effects will be determined via cognitive assessment and compared pre- and post-FEAST treatment.
|
8 weeks
|
Change in Hamilton Depression Rating Score (HDRS)
Time Frame: 8 weeks
|
Change in HDRS from baseline to completion of each ECT treatment compared between 2 treatments - FEAST or FEAST RP.
HDRS is a 24-item interview-based tool measuring depression symptoms in the previous week.
Scoring is based on only the first 17 items.
Eight items are scored on a 5-point scale, ranging from 0 = not present to 4 = severe.
Nine are scored from 0-2.
Total scores are the sum of the 17 item scores and range from 0 (Normal functioning) to 22 (severe depression).
|
8 weeks
|
Change in Inventory for Depressive Symptoms - Self Report (IDS-SR) Score
Time Frame: 8 weeks
|
Change in IDS-SR scores from baseline to completion of each ECT treatment compared between 2 treatments - FEAST or FEAST RP.
IDS-SR is a 30-item self report tool measuring depression symptoms in the previous week.
Items are scored from 1 (normal functioning) to 3 (severely impaired) with some items scored on a yes (score of 1) or no (score of zero) basis.
Items are summed to calculate the total score, which ranges from 0 (normal functioning) to 84 (severely impaired).
|
8 weeks
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Ziad Nahas, MD, University of Minnesota
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- PSYCH-2019-27591
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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