SMTr-METAB : FDG-PET Assessment of Cerebral Metabolism in Resistant Depression Treated With rTMS (SMTr-METAB)
Cerebral Functional Modifications After Low Frequency Repetitive Transcranial Magnetic Stimulation in Refractory Depression. Assessment With 18F-FDG-PET Imaging.
研究概览
详细说明
In France, lifetime prevalence of depression is 21 %, with major consequences: handicap, loss of productivity, reduction in quality of life, increased mortality. The efficient and long-lasting care of depression is consequently a priority of public health.
Despite well-conducted conventional therapeutic strategies, it is estimated that about 30 % of the depressed patients do not respond at all to an antidepressant, that 30 % will present a partial response, and that 40 % only patients will have a complete remission.
Non-pharmacological alternative treatments have been promoted, particularly with repetitive transcranial magnetic stimulation (rTMS). A recent meta-analysis with 29 randomized controlled trials versus placebo reports a 29.3 % response rate and a 18.6 % remission rate after active stimulation vs respectively, 10.4 % and 5 % after placebo stimulation.
However, predictive biomarkers of response are unknown, and cerebral metabolism may be a good candidate. It is admitted that the depressive state is correlated with specific modifications of glucose metabolism in circuits which are involved in the neurobiology of depression. The amplitude of these changes may correlate with clinical severity or may differ with treatment type, and cerebral metabolic changes might be an additional guide to treatment. Finally, the therapeutic effect might normalize cerebral functional activity and this might be an early correlate of clinical response. However the studies using functional imaging in a therapeutic approach or in the understanding of the physiopathology of the depression are not usable in a clinical practice of routine.
The investigators suggest using a well-known analysis software (Scenium software, Siemens GmbH) who allows an automated analysis by the distribution of the cerebral metabolism by means of the F18-FDG TEP-TDM and a quantitative measure, expressed in regional consumption of glucose expressed by g / 100 g / min for every 18F-FDG TEP-TDM and for every region of interest. Image registering by the camera, remote of the injection of the tracer, lasts less than 10 minutes.The software also allows to compare the data acquired for a patient with a standardized database.
The investigators will perform a opened study in two centers (Monaco Hospital/Nice CHU) on 50 depressed patients aged from 40 to 65 years old, not having answered 2 lines of well led antidepressants. Low-frequency rTMS will be proposed in acute cure (3 in 6 weeks) in monotherapy followed by 6 months of rTMS for patients who have responded to acute treatment phase.
Cerebral metabolic modifications (location and intensity) will be calculated after two PET-TDM in every patient, realized before and after the acute treatment by rTMS. We shall use the SCENIUM software which allows to compare each patient's data with a standardized database.
At the end of the acute period of treatment, it will be proposed to patients who have responded to pursue rTMS treatment in a consolidation phase for 6 months. All patients will be longitudinally assessed during this consolidation period. One objective is to assess if initial TEP-TDM data and/or the amplitude of the induced metabolic variation is associated with the stability of the clinical answer in respondent patients
研究类型
注册 (实际的)
阶段
- 不适用
联系人和位置
参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
- Subject from 40 to 65 years old
- Characterized current depressive Episode, unipolar, without psychotic characteristic (according to DSM IV-TR)
- Presenting to the inclusion a score upper or equal to 20 on the scale HDRS-17
- Absence of answer or partial clinical answer to more than two antidepressant treatments of different therapeutic classes to effective posology on a duration of at least 6 weeks
- Patient affiliated to French social security
- Patient must give a written, signed and dated informed consent before any study related activity is performed. Where relevant, a legal representative will also sign the informed study consent according to local laws and regulations
Exclusion Criteria:
- Failure in a previous low-frequency rTMS cure (at least 15 sessions)
- Failure in a cure of bilateral ECT (at least 8 sessions) or unilateral (at least 10 sessions)
- Mental disorder owed to a general medical affection ( DSM-IV)
- Presence of a neurodegenerative pathology in the inclusion estimated on the clinical examination, the intellectual MRI, the TEP / TDM at the 18F-FDG and the neuropsychological profile in the inclusion
- Severe or not stabilized somatic Disease
- chronic depression evolving for more than 3 years
- Not answer in more of therapeutic antidepressive five well (documented) conducts
- Presence of contraindication the SMTr, of which epileptic disease
- Schizophrenic Disorder
- Addicting Disorder with current dependence (alcohol, cannabis, benzodiazepin)
- Bipolar disorder (I, II)
- Disorder of personality to cluster A and B co-morbid
- Pregnant Woman (dosage of urinary Beta-HCG)
- Vulnerable Person: major under guardianship or guardianship, minor
- Mental Deficiency of the subject making its participation on approval impossible
- Participation in another clinical trial
学习计划
研究是如何设计的?
设计细节
- 主要用途:基础科学
- 分配:不适用
- 介入模型:单组作业
- 屏蔽:无(打开标签)
武器和干预
参与者组/臂 |
干预/治疗 |
---|---|
实验性的:Patient
Patient with resistant depression treated with rTMS
|
研究衡量的是什么?
主要结果指标
结果测量 |
措施说明 |
大体时间 |
---|---|---|
Variation of the regional cerebral glucose consumption between the two PET-TDM
大体时间:at week 6
|
Variation of the regional cerebral glucose consumption between the two PET-TDM (realized at inclusion and at Week 6)
|
at week 6
|
次要结果测量
结果测量 |
大体时间 |
---|---|
Comparison of local glucose use between responder and non-responder patients
大体时间:at week 6
|
at week 6
|
合作者和调查者
研究记录日期
研究主要日期
学习开始 (实际的)
初级完成 (实际的)
研究完成 (实际的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (估计)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
此信息直接从 clinicaltrials.gov 网站检索,没有任何更改。如果您有任何更改、删除或更新研究详细信息的请求,请联系 register@clinicaltrials.gov. clinicaltrials.gov 上实施更改,我们的网站上也会自动更新.
rTMS的临床试验
-
Changping LaboratoryBeijing HuiLongGuan Hospital招聘中
-
National Institute of Neurological Disorders and...完全的