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Brain implant may lift most severe depression

An electrical implant that sits in the skull and is wired to the brain can detect and treat severe depression, US scientists believe after promising results with a first patient.


Sarah, who is 36, had the device fitted more than a year ago and says it has turned her life around.


凯瑟琳·斯坎戈斯教授检查莎拉的装置和进步 。

The matchbox-sized pack in her head is always "on" but only delivers an impulse when it senses she may need it.


The experimental study is described in Nature Medicine journal.


The researchers, from University of California, San Francisco, stress it is too soon to say if it might help other patients, like Sarah, with hard-to-treat depression, but they are hopeful and plan more trials.


Depression circuits


Sarah is the first person to have had the experimental therapy.


She'd had a succession of failed treatments, including anti-depressants and electroconvulsive therapy in recent years.

之前她曾吃过抗抑郁药物,最近几年接受电痉挛疗法(electroconvulsive therapy),但都以失败告终。

The surgery may sound daunting, but Sarah said the prospect of gaining "any kind of relief" was better than the darkness she had been experiencing.


"I had exhausted all possible treatment options.My daily life had become so restricted. I felt tortured each day. I barely moved or did anything."


The surgery involved drilling small holes in her skull to fit the wires that would monitor and stimulate her brain.


The box, containing the battery and the pulse generator, was tucked into the bone, beneath her scalp and hair.


The procedure took a full working day and was done under general anaesthetic, meaning Sarah was unconscious throughout.


Sarah says when she woke, up she felt euphoric.


"When the implant was first turned on, my life took an immediate upward turn. My life was pleasant again."


"Within a few weeks, the suicidal thoughts disappeared."


"When I was in the depths of depression all I saw is what was ugly."


A year on, Sarah remains well, with no side-effects.


"The device has kept my depression at bay, allowing me to return to my best self and rebuild a life worth living."


She can't feel the device as it fires, but says: "I could probably tell you within 15 minutes that it has gone off because of a sense of alertness and energy or the positivity I will feel."


How it works


Researcher Dr Katherine Scangos, who is a psychiatrist at the university, said the innovation was made possible by locating the "depression circuits" in Sarah's brain.


"We found one location, which is an area called the ventral striatum, where stimulation consistently eliminated her feelings of depression.

斯坎戈斯博士表示,他们找到了一个叫腹侧纹状体(ventral striatum)的位置, 通过不断刺激该部位可以消除莎拉的抑郁感。

"And we also found a brain activity area in the amygdala that could predict when her symptoms were most severe."

“我们还在大脑杏仁核内发现一个大脑活动区,这一区域可以预测她的症状何时最严重,” 斯坎戈斯博士说。

The scientists say a lot more research is needed to test the experimental therapy and determine if it can help more people with severe depression, and perhaps other conditions too.


Personalised treatment


Dr Scangos, who has enrolled two other patients in the trial and hopes to recruit nine more, said: "We need to look at how these circuits vary across patients and repeat this work multiple times.


"And we need to see whether an individual's biomarker or brain circuit changes over time as the treatment continues.We didn't know if we were going to be able to treat her depression at all because it was so severe."


"So in that sense we are really excited about this. It's so needed in the field right now."


Dr Edward Chang, the neurosurgeon who fitted the device, said: "To be clear, this is not a demonstration of efficacy of this approach."

为莎拉装置电子设备的神经外科医生张复伦(Edward Chang)强调,需要说明的是,这并非是要证明这种方法的疗效。

"It's really just the first demonstration of this working in someone and we have a lot of work ahead of us as a field to validate these results to see if this actually is something that will be enduring as a treatment option."


Prof Jonathan Roiser, a neuroscience expert at University College London in the UK, said: "Although this kind of highly invasive surgical procedure would only ever be used in the most severe patients with intractable symptoms, it is an exciting step forward due to the bespoke nature of the stimulation.

英国伦敦大学学院的神经科学专家罗伊瑟教授表示,虽然这种高度创伤性外科手术只应该用于那些患有顽疾的重症患者 ,但刺激大脑的个性化特点代表着“向前迈出了令人兴奋的一步”。

"It is likely that if trialled in other patients, different recording and stimulation sites would be required, as the precise brain circuitry underlying symptoms probably varies between individuals.


"As there was only one patient and no control condition, it remains to be seen whether these promising results hold in clinical trials."

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