Focal Electrically-Administered Seizure Therapy (FEAST) Studies at Two Enrolling Sites to Further Test and Refine the Treatment
| Status: | Recruiting |
|---|---|
| Conditions: | Depression, Neurology |
| Therapuetic Areas: | Neurology, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 90 |
| Updated: | 7/19/2018 |
| Start Date: | August 2015 |
| End Date: | April 2019 |
| Contact: | Mark S George, MD |
| Email: | georgem@musc.edu |
| Phone: | 8438765142 |
Focal Electrically-Administered Seizure Therapy (FEAST): Studies at Two Enrolling Sites to Further Test and Refine the Treatment
This open label investigation further evaluates the safety, efficacy and potential mechanisms
of action of a new form of electroconvulsive therapy (ECT). The investigators have recently
completed preliminary open-label studies with FEAST, first at Columbia University, and then
at the Medical University of South Carolina in Charleston (Nahas et al., 2013b). The
investigators have published the outcomes of the first 17 patients studied. One patient
withdrew from the study after a single titration session. After the course of FEAST (median
10 sessions), there was a 46.1 + 35.5% improvement in Hamilton Rating Scale for Depression
(HRSD24) scores compared to baseline (33.1 + 6.8, 16.8 + 10.9; P < 0.0001). Eight of 16
patients met response criteria (≥50% decrease in HRSD24) and 5/16 met remission criteria
(HRSD24≤10). Patients achieved full re-orientation (4 of 5 items correct) in 5.5 + 6.4 min
(median time = 3.6 min), timed from when their eyes first opened after treatment. The
investigators have now studied 18 more patients (see results below), and we are completing
the study in the original IDE with another two more patients still to enroll.
This work allowed us to refine the treatment. For example, the investigators selectively
modified the electrode geometry to decrease interelectrode resistance. Additionally the
investigators modified the titration schedule, now only administering a standard 800 ma
ultrabrief pulse, and thus no longer titrating in the current domain.
In this next proposed trial we will continue to gather efficacy and safety data, and compare
these to a parallel non-randomized group receiving ECT standard of care.
ECT is typically delivered in a dynamically adaptive manner, with each person having a
different number of treatments, averaging between 8-12 treatment over 4-5 weeks. We thus have
to use imprecise time points such as 'at the end of the acute treatment course' rather than
specified dates or visits.
of action of a new form of electroconvulsive therapy (ECT). The investigators have recently
completed preliminary open-label studies with FEAST, first at Columbia University, and then
at the Medical University of South Carolina in Charleston (Nahas et al., 2013b). The
investigators have published the outcomes of the first 17 patients studied. One patient
withdrew from the study after a single titration session. After the course of FEAST (median
10 sessions), there was a 46.1 + 35.5% improvement in Hamilton Rating Scale for Depression
(HRSD24) scores compared to baseline (33.1 + 6.8, 16.8 + 10.9; P < 0.0001). Eight of 16
patients met response criteria (≥50% decrease in HRSD24) and 5/16 met remission criteria
(HRSD24≤10). Patients achieved full re-orientation (4 of 5 items correct) in 5.5 + 6.4 min
(median time = 3.6 min), timed from when their eyes first opened after treatment. The
investigators have now studied 18 more patients (see results below), and we are completing
the study in the original IDE with another two more patients still to enroll.
This work allowed us to refine the treatment. For example, the investigators selectively
modified the electrode geometry to decrease interelectrode resistance. Additionally the
investigators modified the titration schedule, now only administering a standard 800 ma
ultrabrief pulse, and thus no longer titrating in the current domain.
In this next proposed trial we will continue to gather efficacy and safety data, and compare
these to a parallel non-randomized group receiving ECT standard of care.
ECT is typically delivered in a dynamically adaptive manner, with each person having a
different number of treatments, averaging between 8-12 treatment over 4-5 weeks. We thus have
to use imprecise time points such as 'at the end of the acute treatment course' rather than
specified dates or visits.
This study will provide preliminary evaluation of the following:
1. Further characterization of the efficacy of FEAST and the safety of the treatment.
1. The primary efficacy measure will be the 24-item Hamilton Rating Scale for
Depression. The changes in these scores from before to immediately following the
treatment course (typically after 4 weeks) will be compared in patients treated
with the FEAST methodology and matched to nonrandomized patients at our facilities
who were treated with conventional ECT methods (ultrabrief right unilateral [RUL]
ECT).
2. Acute and subacute cognitive side effects following FEAST will be assessed with a
brief neuropsychological battery. The primary acute measures will be the time to
return of orientation following seizure induction. The primary subacute measures
will be assessment of retrograde amnesia for autobiographical information. The
neuropsychological measures will be compared in the patients treated with the FEAST
methodology (under this IDE) and matched (but nonrandomized) patients who are
treated with conventional ECT methods (also covered under this IDE).
3. Safety will also be determined by examining the number and frequency of serious
adverse advents and adverse events.
2. Characterization of the focal nature of the seizure onset with FEAST and RUL ECT. We
will use two main methods to address the issue of focality.
1. Resting state fMRI before and after a course of FEAST (or conventional RUL ECT). We
will address whether FEAST causes changes in hyper connected prefrontal cortical
subcortical networks, and whether such an effect is more restricted to prefrontal
cortex with FEAST relative to conventional RUL ECT.
2. Peri-ictal EEG acquired immediately before, during and immediately after the FEAST
seizure. We will acquire this in all patients at all treatment sessions. Again, for
comparison, we will use identical EEG acquisition methods in patients treated with
conventional RUL ECT.
1. Further characterization of the efficacy of FEAST and the safety of the treatment.
1. The primary efficacy measure will be the 24-item Hamilton Rating Scale for
Depression. The changes in these scores from before to immediately following the
treatment course (typically after 4 weeks) will be compared in patients treated
with the FEAST methodology and matched to nonrandomized patients at our facilities
who were treated with conventional ECT methods (ultrabrief right unilateral [RUL]
ECT).
2. Acute and subacute cognitive side effects following FEAST will be assessed with a
brief neuropsychological battery. The primary acute measures will be the time to
return of orientation following seizure induction. The primary subacute measures
will be assessment of retrograde amnesia for autobiographical information. The
neuropsychological measures will be compared in the patients treated with the FEAST
methodology (under this IDE) and matched (but nonrandomized) patients who are
treated with conventional ECT methods (also covered under this IDE).
3. Safety will also be determined by examining the number and frequency of serious
adverse advents and adverse events.
2. Characterization of the focal nature of the seizure onset with FEAST and RUL ECT. We
will use two main methods to address the issue of focality.
1. Resting state fMRI before and after a course of FEAST (or conventional RUL ECT). We
will address whether FEAST causes changes in hyper connected prefrontal cortical
subcortical networks, and whether such an effect is more restricted to prefrontal
cortex with FEAST relative to conventional RUL ECT.
2. Peri-ictal EEG acquired immediately before, during and immediately after the FEAST
seizure. We will acquire this in all patients at all treatment sessions. Again, for
comparison, we will use identical EEG acquisition methods in patients treated with
conventional RUL ECT.
Inclusion Criteria:
- Diagnosis of Major Depressive Episode
- Pretreatment Hamilton Depression Score >21
- ECT indicated
- Willing and able to give informed consent
Exclusion Criteria:
- History of schizophrenia, schizoaffective disorder, other functional psychosis, or
rapid cycling bipolar disorder
- History of central nervous system illness or insult other than conditions associated
with psychotropic exposure (e.g., tardive dyskinesia)
- Alcohol or substance abuse or dependence in the past year (DSM-V)
- Secondary diagnosis of a delirium, dementia, or amnestic disorder (DSM-V), pregnancy,
or epilepsy
- Requires especially rapid antidepressant response due to suicidality, psychosis,
inanition, psychosocial obligations, etc.
- No anticonvulsant mood stabilizers (e.g., Depakote, Tegretol, Lamictal); No lithium;
No psychostimulants (e.g., Ritalin, Adderall);
Allowed medications during FEAST/ECT:
Antidepressants, including buproprion Atypical antipsychotics; Hypnotics for sleep;
Anxiolytics (limited to up to 3 mg equivalents/day lorazepam)
- ECT in the past six months
We found this trial at
2
sites
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Charleston, South Carolina 29425
Phone: 843-876-5142
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