Posts Tagged treatment

[WEB PAGE] 3 studies point the way to better treatment for traumatic brain injury

Special emergency training can help save lives

Better training for emergency medical responders may increase the survival rate of patients with severe head injury.

 Better training for emergency medical responders may increase the survival rate of patients with severe head injury.

The National Institutes of Health supports studies that look for better ways to treat traumatic brain injury (TBI) patients.

Here are some recent findings:

Mental health issues may appear after a head injury. About one in five people may experience mental health issues up to six months after a mild head injury or concussion. Researchers found that at three and six months after an injury, some people were more likely to report depression and post-traumatic stress disorder, or PTSD. These findings suggest that follow-up care related to mental health is important.

Microbleeds may worsen a head injury. Tiny, hard-to-detect areas of damage to blood vessels in the brain, called microbleeds, may signal a worse outcome for people with even minor head injuries. Researchers found that patients with microbleeds were more likely to have more physical and mental problems after their injury. Researchers used an advanced brain-imaging scanner to see these small spots. Scanning for this type of damage after a TBI may help doctors know which patients need more intensive treatment.

Better emergency training saves lives. Updated brain-injury training for emergency medical responders may dramatically improve the survival rate of patients with severe head injury. Emergency responders across Arizona were given a short training on the latest TBI guidelines. These include preventing low oxygen, low blood pressure, and hyperventilation. Following those guidelines helped double the survival rate of people with severe TBI. This outcome shows the benefits of a simple, two-hour training session for emergency services providers.

via 3 studies point the way to better treatment for traumatic brain injury | NIH MedlinePlus Magazine

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[Information/Educational Page] Driving After Mild Stroke – Archives of Physical Medicine and Rehabilitation

First page of article

In the U.S. over 305,000 people have a mild stroke each year.1 Even mild stroke may lead to difficulties with physical function, thinking, and vision.2 Because of these challenges, people with mild stroke can complete basic tasks fairly easily, but may have difficulty returning to complex tasks like driving.2 Approximately 1 out of every 5 adults with mild stroke report difficulty with driving.3

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via Driving After Mild Stroke – Archives of Physical Medicine and Rehabilitation

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[Abstract] The effectiveness of somatosensory retraining for improving sensory function in the arm following stroke: a systematic review

The aim of this study was to evaluate if somatosensory retraining programmes assist people to improve somatosensory discrimination skills and arm functioning after stroke.

Nine databases were systematically searched: Medline, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, Embase, Amed, Web of Science, Physiotherapy Evidence Database, OT seeker, and Cochrane Library.

Studies were included for review if they involved (1) adult participants who had somatosensory impairment in the arm after stroke, (2) a programme targeted at retraining somatosensation, (3) a primary measure of somatosensory discrimination skills in the arm, and (4) an intervention study design (e.g. randomized or non-randomized control designs).

A total of 6779 articles were screened. Five group trials and five single case experimental designs were included (N = 199 stroke survivors). Six studies focused exclusively on retraining somatosensation and four studies focused on somatosensation and motor retraining. Standardized somatosensory measures were typically used for tactile, proprioception, and haptic object recognition modalities. Sensory intervention effect sizes ranged from 0.3 to 2.2, with an average effect size of 0.85 across somatosensory modalities. A majority of effect sizes for proprioception and tactile somatosensory domains were greater than 0.5, and all but one of the intervention effect sizes were larger than the control effect sizes, at least as point estimates. Six studies measured motor and/or functional arm outcomes (n = 89 participants), with narrative analysis suggesting a trend towards improvement in arm use after somatosensory retraining.

Somatosensory retraining may assist people to regain somatosensory discrimination skills in the arm after stroke.

via The effectiveness of somatosensory retraining for improving sensory function in the arm following stroke: a systematic review – Megan L Turville, Liana S Cahill, Thomas A Matyas, Jannette M Blennerhassett, Leeanne M Carey, 2019

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[ARTICLE] Social cognition and emotion regulation: a multifaceted treatment (T-ScEmo) for patients with traumatic brain injury – Full Text

Many patients with moderate to severe traumatic brain injury have deficits in social cognition. Social cognition refers to the ability to perceive, interpret, and act upon social information. Few studies have investigated the effectiveness of treatment for impairments of social cognition in patients with traumatic brain injury. Moreover, these studies have targeted only a single aspect of the problem. They all reported improvements, but evidence for transfer of learned skills to daily life was scarce. We evaluated a multifaceted treatment protocol for poor social cognition and emotion regulation impairments (called T-ScEmo) in patients with traumatic brain injury and found evidence for transfer to participation and quality of life.

In the current paper, we describe the theoretical underpinning, the design, and the content of our treatment of social cognition and emotion regulation (T-ScEmo).

The multifaceted treatment that we describe is aimed at improving social cognition, regulation of social behavior and participation in everyday life. Some of the methods taught were already evidence-based and derived from existing studies. They were combined, modified, or extended with newly developed material.

T-ScEmo consists of 20 one-hour individual sessions and incorporates three modules: (1) emotion perception, (2) perspective taking and theory of mind, and (3) regulation of social behavior. It includes goal-setting, psycho-education, function training, compensatory strategy training, self-monitoring, role-play with participation of a significant other, and homework assignments.

It is strongly recommended to offer all three modules, as they build upon each other. However, therapists can vary the time spent per module, in line with the patients’ individual needs and goals. In future, development of e-learning modules and virtual reality sessions might shorten the treatment.

Traumatic brain injury refers to a brain lesion caused by an external mechanical force, leading not only to physical impairments and cognitive deficits, but also to changes in behavior and personality.1,2 Especially after damage to orbitofrontal and ventromedial prefrontal brain areas, deficits in social cognition can occur.3,4

According to Adolphs,5 social cognition consists of three stages: (1) the ability to perceive social information (i.e. emotional facial expressions, bodily language), (2) the capacity to process and interpret social information (i.e. theory of mind, perspective taking), and (3) the ability to adapt behavior in accordance with the situation. Babbage et al.6 estimated that 13%–39% of individuals with moderate to severe traumatic brain injury experienced emotion perception deficits and up to 70% reported low empathy.79

Deficits in social cognition often appear in the shape of socially inadequate behavior, such as disinhibited or indifferent emotional behavior.1012 Such behaviors have detrimental consequences for the ability of patients to establish and maintain social relationships, to hold jobs, and to participate in society.1,13,14 It has been found that poor theory of mind and behavioral problems significantly predict poor participation and community integration.15,16For all these reasons, it is important to provide a tailored rehabilitation treatment, in order to prevent an unfavorable outcome.

In their review of cognitive rehabilitation, Cicerone et al.17 stressed the need to provide detailed information about the theoretical base, the protocol design, and the ingredients of a treatment, as a prerequisite to analyze its effectiveness. In the current paper, we give a comprehensive description of the treatment of social cognition and emotion regulation protocol (T-ScEmo). The effectiveness of T-ScEmo was evaluated in 59 patients with traumatic brain injury. It was compared with a computerized control treatment in a randomized controlled trial.18 Compared to the control treatment, T-ScEmo resulted in significant improvements in emotion recognition, theory of mind, emphatic behavior, quality of life partner relationship, quality of life and societal participation, up to five months posttreatment. Patients with traumatic brain injury as well as their life partners were satisfied with the treatment.18 A detailed description of the T-ScEmo protocol is relevant for researchers and clinical therapists; they can use, replicate, or expand this newly developed treatment.[…]

 

Continue —-> Social cognition and emotion regulation: a multifaceted treatment (T-ScEmo) for patients with traumatic brain injury – Herma J Westerhof-Evers, Annemarie C Visser-Keizer, Luciano Fasotti, Jacoba M Spikman, 2019

 

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Figure 1. Thoughts–feelings–behavior scheme (module 2).

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[WEB SITE] Stroke alert

Stroke alert

To mark the World Stroke Day observed on October 29, experts emphasise on the key issues related to it and the needs of stroke survivors and caregivers. Pioneer Health reports

What is stroke?

Stroke or brain attack is potentially life-threatening in which a part of the brain is deprived of adequate oxygen and energy. Stroke may be ischemic due to clotting in artery of brain that results in the brain damage, or it may be haemorrhagic due to tear in the wall of artery that results in bleeding in the brain. Nearly 80 per cent of all strokes are ischemic.

— Dr KM Hassan, Associate Director & Head, Department of Neurology,

Jaypee Hospital, Noida

How to Recognise?

Warming signs

  • Sudden weakness or numbness of face, arm or leg on one side of body
  • Sudden loss of vision— particularly in one eye
  • Sudden loss of speech or trouble talking or understanding speech
  • Sudden severe headaches
  • Sudden confusion
  • Sudden dizziness, unsteadiness or falls

The pneumonic — BEFAST — can help people to remember the symptoms:

B: Balance loss

E: vision loss in one or both Eyes

F: fascial tilt

A: Arm drift

S: Speech slurring or loss

F: time to act Fast.

People must be aware of these symptoms and caregivers need to be extra careful in recognising these.

—Dr Vinit Suri, senior consultant, neurology, Indraprastha Apollo Hospitals and President, Indian Stroke Association

Factfile

Stroke is the third commonest cause of death worldwide and there is an increase in the number of stroke patients with disabilities every day.  India and China contribute to 40 per cent of world’s stroke patients. Increased prevalence of diabetes, high blood pressure, heart problems are directly contributing to the increased stroke prevalence.

Diet which is high in carbohydrates and fats add to the risk.  There is a pandemic of obesity in our country along with sleep apnea, which adds to the risk of stroke. It’s unfortunate to note that 20 per cent of stroke patients are less than 40 years of age. Stroke in young patients cause significant morbidity and has a huge impact  economically as well in the family.  This year, world stroke day 2018 is celebrated with the theme of “#up again after stroke” to reinstate hope among stroke survivors

Every minute after stroke 1.9 million brain cells (neurons) die and 84km of nerve fibers get permanently damaged.

— Dr Suryanarayana Sharma, consultant, neurologist & stroke specialist, head – division of Stroke & Neurosonology, BGS Gleneagles Global Hospitals

Nine preventive strategies

The nine preventive strategies for stroke include control of blood pressure, control of diabetes, controlling cholesterol levels, regular exercise, stopping smoking and tobacco chewing, reduction of body weight, appropriate diet modification, avoiding alcohol or drinking in moderation and controlling cardiac disease especially atrial fibrillation.

—Dr Suri

Treatable risk factors

  • High blood pressure: Increases the risk two fold. This is because it can narrow the blood vessels causing them to rupture or leak. It can also result in the formation of blood clots which further increase the risk of stroke.
  • Smoking: It is known to cause stroke as it leads to increased blood pressure which can cause the blood to clot and additionally builds up fatty substance in the main artery which provides blood to the brain.
  • Diabetes: Doubles the risk. High blood sugar in the blood can damage blood vessels making them harder, narrower and more likely to be blocked.
  • High Levels of cholesterol: Low-density lipoprotein cholesterol carries cholesterol through the blood which causes blockage. The build of plaque in the arteries makes it difficult for the blood to carry the oxygen to the brain.

  — Dr Rajesh Garg, director and HOD, Neurology, Fortis Hospital, Shalimar Bagh

Treatment

Up to 85 per cent of all strokes are ischemic. For this, there is an option of intravenous medication called TPA (recombinant tissue plasminogen activator) available which can be given to the patient within first 3 to 4.5 hours of the symptom onset. The patients who have a blockage in a large blood vessel can be offered mechanical thrombectomy or ‘clot buster’ drug up to 24 hours, but sooner the better), which involves removing the blockage in the blood vessel and restoring the blood supply.  This procedure is done through a small nick in the groin. Trials have shown that patients do well post mechanical thrombectomy and have a greater chance to live independently.

— Dr Chandril Chugh, senior consultant & head – Interventional Neurology, Max Super Speciality Hospital, Saket

Understanding the golden hour

It is imperative for a stroke patient to get to the hospital in the ‘Golden Period’, that is within first 4.5 hours (the sooner the better). This is because clot busting medication will be effective if administered within 4.5 hours. For every minute in which the blood flow is not restored, nearly two million additional nerve cells die.It is important that patient should reach an equipped stroke centre as early as possible.

— Dr Garg

Caring for a stroke patient at home

  • A patient may undergo behavioural problems like depression. It is important to ensure that they feel  supported. Making them a part of a support group is one way to enable them to handle their emotions.
  • Motor-skill exercises can help improve their muscle strength.
  • Forced – use therapy: An unaffected limb is restrained while they practice moving the affected limb to help improve its function.
  • Range-of-motion therapy: Certain exercises and treatments can ease muscle tension and help them regain range of motion.
  • Functional electrical stimulation: Electricity is applied to weakened muscles, causing them to contract and may help re-educate muscles.
  • Robotic devices can assist impaired limbs with performing repetitive motions, helping the limbs to regain strength and function
  • Virtual reality: The use of video games and other computer-based therapies involves interacting with a simulated, real-time environment
  • Therapy for cognitive disorders: Occupational therapy and speech therapy can help them with lost cognitive abilities, such as memory, processing, problem-solving, social skills, judgment and safety awareness
  • Therapy for communication disorders: Speech therapy can help them regain lost abilities in speaking, listening and writing.
  • Treatments such as massage, herbal therapy, acupuncture and oxygen therapy are being evaluated

—Dr Garg

 

via Stroke alert

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[Abstract] Combined transcranial direct current stimulation with virtual reality exposure for posttraumatic stress disorder: Feasibility and pilot results

Abstract

Background

Facilitating neural activity using non-invasive brain stimulation may improve extinction-based treatments for posttraumatic stress disorder (PTSD).

Objective/hypothesis

Here, we examined the feasibility of simultaneous transcranial direct current stimulation (tDCS) application during virtual reality (VR) to reduce psychophysiological arousal and symptoms in Veterans with PTSD.

Methods

Twelve Veterans with PTSD received six combat-related VR exposure sessions during sham-controlled tDCS targeting ventromedial prefrontal cortex. Primary outcome measures were changes in skin conductance-based arousal and self-reported PTSD symptom severity.

Results

tDCS + VR components were combined without technical difficulty. We observed a significant interaction between reduction in arousal across sessions and tDCS group (p = .03), indicating that the decrease in physiological arousal was greater in the tDCS + VR versus sham group. We additionally observed a clinically meaningful reduction in PTSD symptom severity.

Conclusions

This study demonstrates feasibility of applying tDCS during VR. Preliminary data suggest a reduction in psychophysiological arousal and PTSD symptomatology, supporting future studies.

via Combined transcranial direct current stimulation with virtual reality exposure for posttraumatic stress disorder: Feasibility and pilot results – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation

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[WEB PAGE] Depression – NIMH

Depression

Overview

Depression (major depressive disorder or clinical depression) is a common but serious mood disorder. It causes severe symptoms that affect how you feel, think, and handle daily activities, such as sleeping, eating, or working. To be diagnosed with depression, the symptoms must be present for at least two weeks.

Some forms of depression are slightly different, or they may develop under unique circumstances, such as:

  • Persistent depressive disorder (also called dysthymia) is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for two years to be considered persistent depressive disorder.
  • Postpartum depression is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies.
  • Psychotic depression occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.
  • Seasonal affective disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. This depression generally lifts during spring and summer. Winter depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
  • Bipolar disorder is different from depression, but it is included in this list is because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major depression (called “bipolar depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”

Examples of other types of depressive disorders newly added to the diagnostic classification of DSM-5 include disruptive mood dysregulation disorder (diagnosed in children and adolescents) and premenstrual dysphoric disorder (PMDD).

Signs and Symptoms

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

  • Persistent sad, anxious, or “empty” mood
  • Feelings of hopelessness, or pessimism
  • Irritability
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy or fatigue
  • Moving or talking more slowly
  • Feeling restless or having trouble sitting still
  • Difficulty concentrating, remembering, or making decisions
  • Difficulty sleeping, early-morning awakening, or oversleeping
  • Appetite and/or weight changes
  • Thoughts of death or suicide, or suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

Risk Factors

Depression is one of the most common mental disorders in the U.S. Current research suggests that depression is caused by a combination of genetic, biological, environmental, and psychological factors.

Depression can happen at any age, but often begins in adulthood. Depression is now recognized as occurring in children and adolescents, although it sometimes presents with more prominent irritability than low mood. Many chronic mood and anxiety disorders in adults begin as high levels of anxiety in children.

Depression, especially in midlife or older adults, can co-occur with other serious medical illnesses, such as diabetes, cancer, heart disease, and Parkinson’s disease. These conditions are often worse when depression is present. Sometimes medications taken for these physical illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

Risk factors include:

  • Personal or family history of depression
  • Major life changes, trauma, or stress
  • Certain physical illnesses and medications

Treatment and Therapies

Depression, even the most severe cases, can be treated. The earlier that treatment can begin, the more effective it is. Depression is usually treated with medicationspsychotherapy, or a combination of the two. If these treatments do not reduce symptoms, electroconvulsive therapy (ECT) and other brain stimulation therapies may be options to explore.

Quick Tip: No two people are affected the same way by depression and there is no “one-size-fits-all” for treatment. It may take some trial and error to find the treatment that works best for you.

Medications

Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment.

If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.

To find the latest information about antidepressants, talk to your doctor and visit www.fda.gov.

You may have heard about an herbal medicine called St. John’s wort. Although it is a top-selling botanical product, the FDA has not approved its use as an over-the-counter or prescription medicine for depression, and there are serious concerns about its safety (it should never be combined with a prescription antidepressant) and effectiveness. Do not use St. John’s wort before talking to your health care provider. Other natural products sold as dietary supplements, including omega-3 fatty acids and S-adenosylmethionine (SAMe), remain under study but have not yet been proven safe and effective for routine use. For more information on herbal and other complementary approaches and current research, please visit the National Center for Complementary and Integrative Health website.

Psychotherapies

Several types of psychotherapy (also called “talk therapy” or, in a less specific form, counseling) can help people with depression. Examples of evidence-based approaches specific to the treatment of depression include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and problem-solving therapy. More information on psychotherapy is available on the NIMH websiteand in the NIMH publication Depression: What You Need to Know.

Brain Stimulation Therapies

If medications do not reduce the symptoms of depression, electroconvulsive therapy (ECT) may be an option to explore. Based on the latest research:

  • ECT can provide relief for people with severe depression who have not been able to feel better with other treatments.
  • Electroconvulsive therapy can be an effective treatment for depression. In some severe cases where a rapid response is necessary or medications cannot be used safely, ECT can even be a first-line intervention.
  • Once strictly an inpatient procedure, today ECT is often performed on an outpatient basis. The treatment consists of a series of sessions, typically three times a week, for two to four weeks.
  • ECT may cause some side effects, including confusion, disorientation, and memory loss. Usually these side effects are short-term, but sometimes memory problems can linger, especially for the months around the time of the treatment course. Advances in ECT devices and methods have made modern ECT safe and effective for the vast majority of patients. Talk to your doctor and make sure you understand the potential benefits and risks of the treatment before giving your informed consent to undergoing ECT.
  • ECT is not painful, and you cannot feel the electrical impulses. Before ECT begins, a patient is put under brief anesthesia and given a muscle relaxant. Within one hour after the treatment session, which takes only a few minutes, the patient is awake and alert.

Other more recently introduced types of brain stimulation therapies used to treat medicine-resistant depression include repetitive transcranial magnetic stimulation (rTMS) and vagus nerve stimulation (VNS). Other types of brain stimulation treatments are under study. You can learn more about these therapies on the NIMH Brain Stimulation Therapies webpage.

If you think you may have depression, start by making an appointment to see your doctor or health care provider. This could be your primary care practitioner or a health provider who specializes in diagnosing and treating mental health conditions. Visit the NIMH Find Help for Mental Illnesses if you are unsure of where to start.

Beyond Treatment: Things You Can Do

Here are other tips that may help you or a loved one during treatment for depression:

  • Try to be active and exercise.
  • Set realistic goals for yourself.
  • Try to spend time with other people and confide in a trusted friend or relative.
  • Try not to isolate yourself, and let others help you.
  • Expect your mood to improve gradually, not immediately.
  • Postpone important decisions, such as getting married or divorced, or changing jobs until you feel better. Discuss decisions with others who know you well and have a more objective view of your situation.
  • Continue to educate yourself about depression.

Join a Study

What are Clinical Trials?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions, including depression. During clinical trials, some participants receive treatments under study that might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. Other participants (in the “control group”) receive a standard treatment, such as a medication already on the market, an inactive placebo medication, or no treatment. The goal of clinical trials is to determine if a new test or treatment works and is safe. Although individual participants may benefit from being part of a clinical trial, participants should be aware that the primary purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

Please Note: Decisions about whether to participate in a clinical trial, and which ones are best suited for a given individual, are best made in collaboration with your licensed health professional.

How do I find a Clinical Trials at NIMH on Depression?

Doctors at NIMH are dedicated to mental health research, including clinical trials of possible new treatments as well as studies to understand the causes and effects of depression. The studies take place at the NIH Clinical Center in Bethesda, Maryland and require regular visits. After the initial phone interview, you will come to an appointment at the clinic and meet with one of our clinicians. Find NIMH studies currently recruiting participants with depression by visiting Join a Research Study: Depression.

How Do I Find a Clinical Trial Near Me?

To search for a clinical trial near you, you can visit ClinicalTrials.gov. This is a searchable registry and results database of federally and privately supported clinical trials conducted in the United States and around the world (search: depression). ClinicalTrials.gov gives you information about a trial’s purpose, who may participate, locations, and contact information for more details. This information should be used in conjunction with advice from health professionals.

Learn More

Free Booklets and Brochures

  • Chronic Illness & Mental Health: This brochure discusses chronic illnesses and depression, including symptoms, health effects, treatment, and recovery.
  • Depression and College Students: This brochure describes depression, treatment options, and how it affects college students.
  • Depression and Older AdultsDepression is not a normal part of aging. This brochure describes the signs, symptoms, and treatment options for depression in older adults.
  • Depression: What You Need to Know: This booklet contains information on depression including signs and symptoms, treatment and support options, and a listing of additional resources.
  • Postpartum Depression Facts: A brochure on postpartum depression that explains its causes, symptoms, treatments, and how to get help.
  • Teen Depression: This flier for teens describes depression and how it differs from regular sadness. It also describes symptoms, causes, and treatments, with information on getting help and coping.

Clinical Trials

Federal Resources

Research and Statistics

  • Journal Articles: This webpage provides information on references and abstracts from MEDLINE/PubMed (National Library of Medicine).
  • Statistics: Major Depression: This webpage provides information on the statistics currently available on the prevalence and treatment of depression among people in the U.S.

Multimedia

Last Revised: February 2018

 

via NIMH » Depression

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[Abstract] Effects of Electrical Stimulation in Tinnitus Patients: Conventional Versus High-Definition tDCS

Abstract

Background. Contradictory results have been reported for transcranial direct current stimulation (tDCS) as treatment for tinnitus. The recently developed high-definition tDCS (HD tDCS) uses smaller electrodes to limit the excitation to the desired brain areas.

Objective. The current study consisted of a retrospective part and a prospective part, aiming to compare 2 tDCS electrode placements and to explore effects of HD tDCS by matched pairs analyses.

Methods. Two groups of 39 patients received tDCS of the dorsolateral prefrontal cortex (DLPFC) or tDCS of the right supraorbital–left temporal area (RSO-LTA). Therapeutic effects were assessed with the tinnitus functional index (TFI), a visual analogue scale (VAS) for tinnitus loudness, and the hyperacusis questionnaire (HQ) filled out at 3 visits: pretherapy, posttherapy, and follow-up. With a new group of patients and in a similar way, the effects of HD tDCS of the right DLPFC were assessed, with the tinnitus questionnaire (TQ) and the hospital anxiety and depression scale (HADS) added.

Results. TFI total scores improved significantly after both tDCS and HD tDCS (DLPFC: P < .01; RSO-LTA: P < .01; HD tDCS: P = .05). In 32% of the patients, we observed a clinically significant improvement in TFI. The 2 tDCS groups and the HD tDCS group showed no differences on the evolution of outcomes over time (TFI: P = .16; HQ: P = .85; VAS: P = .20).

Conclusions. TDCS and HD tDCS resulted in a clinically significant improvement in TFI in 32% of the patients, with the 3 stimulation positions having similar results. Future research should focus on long-term effects of electrical stimulation.

via Effects of Electrical Stimulation in Tinnitus Patients: Conventional Versus High-Definition tDCS – Laure Jacquemin, Giriraj Singh Shekhawat, Paul Van de Heyning, Griet Mertens, Erik Fransen, Vincent Van Rompaey, Vedat Topsakal, Julie Moyaert, Jolien Beyers, Annick Gilles, 2018

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[WEB SITE] You have epilepsy… so what!

By Adeela Akmal

 

Epilepsy is not a disease, it is a disorder. People who have epilepsy are fully capable of leading a normal life. Read on to find out more…

health

Epilepsy is not a disease, it is a disorder. People who have epilepsy are fully capable of leading a normal life. Read on to find out more…

Epilepsy is a neurological condition that is estimated to occur in 0.5% to 1% of the population of any country. According to the Department of Neurology, Jinnah Postgraduate Medical Centre, Karachi, one in every hundred Pakistani has epilepsy and at least 5 family members are affected in some way or the other due to it. The condition is also twice as common in rural areas as compared to the urban. Epilepsy is a sudden surge of electrical activity in the brain that causes a temporary disturbance in the messaging systems between the brain cells.

Unfortunately, the condition has been stigmatised in the country due to misinformation. Recently, a press conference was held in a bid to create awareness regarding epilepsy at Najumuddin Auditorium at Jinnah Postgraduate Medical Centre (JPMC) to squash the certain stereotypes of the disorder. According to Prof Dr Hasan Aziz, “It is a common misconception among unaware people that an epilepsy attack is a work of some ‘evil spirit’ or ‘supernatural beings’, or that person can be cured by sniffing a shoe. It is not contagious and is rarely hereditary; and it does not affect your intellectual capabilities. A person can live their life normally if they take their prescribed medicines on time, take care of their diet and sleep.”

There have been many famed personalities like Newton, Tolstoy, Socrates, Da Vinci, to our very own Abdul Sattar Edhi, Nadia Jamil and Suhaee Abro, who are epileptic.

Nadia Jamil, actress and mother of two young boys, was diagnosed with epilepsy in 2011, and has not let that get in the way of her work, “As an actress I need my body to work and as a mother I always have to be energetic. Initially, there was a sense of panic and the limitations of my body hit me, like it would for a person with asthma or diabetes. But, medications have helped me. I cook, clean, shop for groceries, ride a bicycle, work and run after my boys without fear. Epilepsy can be handled with medications and a little care in terms of lifestyle – getting proper rest and full sleep. To anyone who has epilepsy, you are not sick, there isn’t anything that you can’t accomplish. It’s not a disease, it is a condition which can be controlled if taken care,” stated Nadia Jamil while talking to this scribe.

Causes

According to National Epilepsy Centre (NEC) at JPMC, in about 70 per cent of the cases, there seems to be no obvious cause of the condition. However, for the remaining cases, strokes, brain tumours, head trauma (such as occurring during a car crash), infectious diseases (for example: AIDS), congenital abnormalities (prenatal injury, or brain damage that occurred before birth), or development disorders (such as autism or neurofibromatosis) are some of the factors that increase the risk of epilepsy.

Symptoms

The key symptom of epilepsy is repeated seizures. One should immediately consult a doctor if it is a recurring matter. A person may experience convulsions with no fever, short spells of blackout, fainting spells during which bowel and bladder isn’t in control. The person may do unexplainable things such as suddenly become stiff, have bouts of blinking or chewing, or do repetitive or jerking movements.

Treatment

For diagnosis, a person goes through a complete physical and neurological exam, and their clinical history is taken along with a detailed account of their seizure that occurred. Additional testing may include EEG (Electroencephalogram) that detects the brain’s electrical activity.

The epileptic seizures can be controlled with antiepileptic drug (AED) therapy. The doctor will prescribe the dosage according to several factors for a particular individual like age, gender, overall health and the severity of the seizures. So, it is mandatory to take the prescribed dosage with punctuality.

In some cases, if there is an underlying brain condition that is causing these seizures, surgeries can be recommended. And, if the AEDs don’t work, the next step could be surgery.

Precautions

While one is still trying to control their condition, it is imperative to take certain precautions. An epileptic person should avoid all activities that can potentially put their lives at risk like riding or driving a vehicle, working in factories (like having to operate heavy or open machinery) or heights. Anything that involves swimming, working near an open flame should be done under supervision.

There are also certain triggers that can provoke seizures in people with epilepsy like missing medications, consuming recreational drugs and alcoholic beverages, lack of sleep and other drugs that may interfere with the prescribed medicines.

What to do when someone is having a seizure?

Do not panic: If you witness someone having seizures, it’s important for you to stay calm in order to help someone.

Protect the person from potential injuries: Help keeping them from falling and gently guide them to the floor. Remove any objects or furniture that may injure the person.

Place a pillow under their head: If they are already on the ground, turn them to one side and loosen the clothing around their neck. Place something soft under their head.

Don’t force anything: Do not forcibly open or put anything in mouth (water, spoon, cloth). You may end up hurting them and yourself.

Record everything: Record the event on your device to show it to the doctor. Pay close attention to the body movement during seizure, how long it lasted, how the person reacted after and possible injuries.

 

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[WEB SITE] Epilepsy: Statistics, Facts and You

epilepsy introepilepsy intro

Epilepsy is a neurological disorder caused by unusual nerve cell activity in the brain. Each year, about 150,000 Americans are diagnosed with the central nervous system disorder that causes seizures. Over a lifetime, one in 26 people will be diagnosed with it.

Seizures can cause a range of symptoms, from momentarily staring blankly to loss of awareness and uncontrollable twitching. Some seizures can be milder than others, but even minor seizures can be dangerous if they occur during activities like swimming or driving.

Frequency of Types


epilepsy typesepilepsy types

Seizures can be divided into two main types: Focal (partial) seizures and generalized seizures.

Focal seizures can be further divided into two types: simple focal seizures and dyscognitive focal seizures. Simple focal seizures, also called simple partial seizures, affect only one area of the brain. Memory and cognitive abilities remain unimpaired, but a partial seizure might lead to temporary paralysis, visual changes, or difficulty with simple movements. Less than 15 percent of people with epilepsy have simple focal seizures.

A dyscognitive focal seizure only affects a specific part of the brain. Unlike focal seizures, a dyscognitive focal seizure can cause mental confusion, loss of memory, and loss of awareness during the seizure. People having a complex focal seizure may appear unaware or dazed. More than a third of patients with epilepsy have dyscognitive partial seizures.

The second main type of seizure is generalized seizures. Generalized seizures divide into several subtypes. These include:

  • tonic seizure
  • clonic seizure
  • myoclonic
  • absence seizure
  • atonic seizure
  • tonic-clonic seizure

More than 30 percent of people with epilepsy experience generalized seizures.

Types

The area of the brain that is affected by a seizure will determine the symptoms and sensations the seizure causes.

Focal Seizures

This type of seizure affects only a portion of the brain. For that reason, it’s also sometimes called a partial seizure. Focal seizures have two main categories: simple focal seizures and dyscognitive focal seizures.

Simple focal seizures typically cause few symptoms. The symptoms that this type of seizure causes can be easily mistaken for another condition and overlooked. People may experience slightly shifted emotions or moods, involuntary jerking and twitching in body parts, and unusual sensory experiences, such as seeing flashing lights. Simple focal seizures do not cause memory loss.

Dyscognitive focal seizures cause a loss of consciousness or awareness. People who experience this type of seizure will not be aware of what occurred during the seizure. This type of seizure often causes unusual, repetitive movement. These movements might include hand rubbing, swallowing, walking in circles, or chewing.

Generalized Seizures

All types of generalized seizures affect both sides of the brain. Generalized seizures can be divided into six groups:

Absence seizures. This type of seizure leaves a person briefly unaware of their surroundings and actions. Most people who experience an absence seizure stare blankly until the seizure is over. Some will produce a subtle, repetitive body movement. Absence seizures are also called “petit mal” seizures.

Atonic seizures. This type of seizure causes loss of muscle control. A person experiencing an atonic seizure may suddenly fall or collapse. That’s why this type of seizure is sometimes called a drop seizure.

Clonic seizures. People who have clonic seizures will routinely experience rhythmic, repeated jerking movements. The neck, face, and arms are commonly affected.

Myoclonic seizures. This type of seizure causes sudden jerking movements or twitches. These movements commonly happen in the arms and legs.

Tonic seizures. When this seizure begins, the muscles in the affected area of the body will tighten and stiffen. The arms, legs, and back are commonly affected. Most people who experience a tonic seizure will fall to the ground because of their muscle rigidity.

Tonic-clonic seizures. Commonly called “grand mal” seizures, this type of seizure causes loss of consciousness, as well as violent shaking and body stiffening. Some people will lose control of their bladder and may bite their tongue during the seizure.

Prevalence


epilepsy-prevalenceepilepsy-prevalence

One percent of Americans will develop epilepsy in their lifetime. About 2.5 to 3 million people in the U.S. have epilepsy. Additionally, about one in 26 people will experience recurring seizures.

Epilepsy can begin at any age. Studies have not identified a prime diagnosis time, but the incidence rate is highest in children and older adults. Luckily, some children with seizures will eventually grow out of them.

Ages Afflicted

According to the Centers for Disease Control and Prevention, about 2.3 million American adults have epilepsy. More than 467,000 children have been diagnosed with the central nervous system disorder.

Additionally, almost 150,000 people in the U.S. develop epilepsy every year.

Ethnicity Specifics

Researchers are still unclear if ethnicity plays a role in who develops epilepsy. Studies suggest, however, that non-Latino whites are more commonly affected by generalized epilepsy than people of African-American descent.

This finding points to the possibility that our ancestry may help determine who develops epilepsy.

Gender Specifics

Overall, no gender is more likely to develop epilepsy than the other. However, it’s possible each gender is more likely to develop certain subtypes of epilepsy. For example, a study found that symptomatic epilepsies are more common in men than women. Cryptogenic seizures (seizures with no known cause) are more frequent in women.

Risk Factors


epilepsy-risk-factorsepilepsy-risk-factors

These risk factors give you a higher chance of developing epilepsy:

Age. Epilepsy can begin at any age, but more people are diagnosed at two distinct phases in life: childhood and after age 60.

Brain infections. Infections, such as meningitis, inflame the brain and spinal cord and can increase your risk for developing epilepsy.

Childhood seizures. Some children develop seizures not related to epilepsy during their childhood years. Very high fevers may cause these seizures. As they grow older, some of these children may develop epilepsy.

Dementia. People experiencing a decline in mental function may also develop epilepsy. This is most common in older adults.

Family history. If a close family member has epilepsy, you are more likely to develop this disorder.

Head injuries. Previous falls, concussions, or injuries to your head may cause epilepsy. Taking precautions during activities such as bicycling, skiing, and riding a motorcycle can help protect your head against injury and possibly prevent a future epilepsy diagnosis.

Vascular diseases. Blood vessel diseases and strokes can cause brain damage. Damage to any area of the brain may trigger seizures and eventually epilepsy. The best way to prevent epilepsy caused by vascular diseases is to care for your heart and blood vessels with a healthy diet and regular exercise. Also, avoid tobacco use and excessive alcohol consumption.

Complications

Having epilepsy increases your risk for certain complications. Some of these complications are more common than others.

The most common complications include:

Car accidents. Many states do not issue driver’s licenses to people with a history of seizures until they have been seizure-free for a specified period of time. A seizure can cause loss of awareness and affect your ability to control a car. You could injure yourself or others if you have a seizure while driving.

Drowning. People with epilepsy are 15 to 19 times more likely to drown than the rest of the population. That’s because people with epilepsy may have a seizure while in a swimming pool, lake, bathtub, or other body of water. They may be unable to move or may lose awareness of their situation during the seizure. If you swim and have a history of seizures, make sure a lifeguard on duty is aware of your condition. Never swim alone.

Emotional health difficulties. Unfortunately, the emotional toll of epilepsy may be too great for some people to bear alone. Depression, anxiety, and suicidal thoughts and actions are possible complications.

Falling. Certain types of seizures affect your motor movements. You may lose control of your muscle function during a seizure and fall to the ground, hit your head on nearby objects, and even break a bone.

Pregnancy-related complications. Women with epilepsy can get pregnant and have healthy pregnancies and babies, but extra precaution is needed. Some anti-seizure medications can cause birth defects, so you and your doctor need to carefully evaluate your medicines before you plan to get pregnant.

Less common complications include:

Status epilepticus. Severe seizures, ones that are prolonged or happen very frequently, can cause status epilepticus. People with this condition are more likely to develop permanent brain damage.

Sudden unexplained death in epilepsy (SUDEP). Sudden, unexplained death is possible in people with epilepsy, but it is rare. Only two to 18 percent of people with epilepsy die from SUDEP. Doctors do not know what causes SUDEP, but one theory suggests heart and respiratory issues may contribute to the death.

Causes


epilepsy causesepilepsy-causes

In more than half of epilepsy cases, doctors will not be able to identify a cause. These epilepsy cases, called idiopathic epilepsy, make up 60 to 70 percent of epilepsy cases.

The four most common causes of epilepsy are:

Brain infection. Infections such as AIDS, meningitis, and viral encephalitis have been shown to cause epilepsy.

Brain tumor. Tumors in the brain can interrupt normal brain cell activity and cause seizures.

Head trauma. Head injuries can lead to epilepsy. These injuries may include sports injuries, falls, or accidents.

Stroke. Vascular diseases and conditions, such as stroke, interrupt the brain’s ability to function normally. This can cause epilepsy.

Other epilepsy causes include:

Neurodevelopmental disorders. Autism and developmental conditions like it may cause epilepsy.

Genetic factors. Having a close family member with epilepsy increases your risk for developing epilepsy. This suggests an inherited gene may cause epilepsy. It’s also possible specific genes make a person more susceptible to environmental triggers that can lead to epilepsy.

Prenatal factors. During their development, fetuses are particularly sensitive to brain damage. This damage might be the result of physical damage, as well as poor nutrition and reduced oxygen. All of these factors could cause epilepsy or other brain abnormalities in children.

Symptoms

Symptoms of epilepsy depend on the type of seizure you’re experiencing and what parts of the brain are affected.

Some common symptoms of epilepsy include:

  • a staring spell
  • confusion
  • loss of consciousness or recognition
  • uncontrollable movement, often including jerking and pulling
  • repetitive movements
  • convulsing

Tests and Diagnosis

Diagnosing epilepsy requires several types of tests and studies to ensure your symptoms and sensations are the result of epilepsy and not another neurological condition. The tests doctors most commonly use include:

Blood tests. Your doctor will take samples of your blood to test for possible infections or other conditions that might explain your symptoms. The test results might also identify potential causes for epilepsy.

EEG. An electroencephalogram (EEG) is a tool that most successfully diagnoses epilepsy. During an EEG, doctors place electrodes on your scalp. These electrodes sense and record the electrical activity taking place in your brain. Doctors can then examine your brain patterns and find unusual activity, which may signal epilepsy. This test can identify epilepsy even when you’re not having a seizure.

Neurological examination. As with any doctor’s office visit, your doctor will want to complete a full health history. They will want to understand when your symptoms began and what you have experienced. This information can help your doctor determine what tests are needed and what types of treatments may help once a cause is found.

CT scan. A computed tomography (CT) scan takes cross-sectional pictures of your brain. This allows doctors to see into each layer of your brain and find possible causes of seizures, including cysts, tumors, and bleeding.

MRI. Magnetic resonance imaging (MRI) takes a detailed picture of your brain. Doctors can use the images created by an MRI to study very detailed areas of your brain and possibly find abnormalities that may be contributing to your seizures.

fMRI. A functional MRI (fMRI) lets your doctors see your brain in very close detail. An fMRI allows doctors to see how blood flows through your brain. This may help them understand what areas of the brain are involved during a seizure.

PET scan. A positron emission tomography (PET) scan uses small amounts of low-dose radioactive material to help doctors see your brain’s electrical activity. The material is injected into a vein and a machine can then take pictures of the material once it has made its way to your brain.

Treatment

Seventy percent of people with epilepsy can find ease and relief from their symptoms with the most common forms of treatment. Treatment might be as simple as taking an anti-epileptic medication. Others may require more invasive treatments. The most common treatments for epilepsy include:

Medication. Anti-epileptic medicines are very effective for most people. It’s also possible you will be able to discontinue taking these medicines after a certain period of time.

Surgery. In some cases, imaging tests can detect the area of the brain responsible for the seizure. If this area of the brain is very small and well defined, doctors may perform surgery to remove the portions of the brain that are responsible for the seizures. If your seizures originate in a part of the brain that cannot be removed, your doctor may still be able to perform a procedure that can help prevent the seizures from spreading to other areas of the brain.

Vagus nerve stimulation. Doctors can implant a device under the skin of your chest. This device is connected to the vagus nerve in the neck. The device sends electrical bursts through the nerve and into the brain. These electrical pulses have been shown to reduce seizures by 20 to 40 percent.

When to See a Doctor

A seizure can be very scary, especially if it’s happening for the first time. Once you have been diagnosed with epilepsy, you will learn to manage your seizures in a healthy way. However, a few circumstances may require you to seek immediate medical help. These circumstances include:

  • injuring yourself during a seizure
  • having a seizure that lasts more than 5 minutes
  • failing to regain consciousness or not breathing after the seizure ends
  • having a high fever in addition to the seizures
  • having diabetes
  • having a second seizure immediately after a first
  • a seizure caused by heat exhaustion

Prognosis


epilepsy prognosisepilepsy prognosis

A person’s prognosis depends entirely on the type of epilepsy they have and the seizures it causes.

More than 60 percent of people will respond positively to the first anti-epileptic drug prescribed to them. Others may require additional assistance finding a medicine that is most effective. Almost all patients will find relief from their epilepsy symptoms with a medication.

After being seizure-free for about two to five years, 50 percent of patients will be able to stop using their anti-epileptic medicines.

Worldwide Facts

Worldwide, 50 million people have epilepsy. Almost 80 percent of these people live in developing regions of the world.

Epilepsy can be successfully treated, but more than 75 percent of patients living in developing areas do not receive the treatment they need for their seizures.

Prevention

Epilepsy may not be preventable for some people. However, you can take certain precautions. These include:

Protect against head injury. Accidents, falls, and injuries to the head may cause epilepsy. Wear protective headgear when you’re bicycling, skiing, or engaging in any event that puts you at risk for a head injury.

Guard against prenatal injury. Taking good care of yourself while you’re pregnant helps protect your baby against certain health conditions, including epilepsy.

Be vaccinated. Childhood vaccinations can guard against diseases that might lead to epilepsy.

Costs

Each year, Americans spend more than $15.5 billion caring for and treating epilepsy.

Other Surprising Facts or Information

Having a seizure doesn’t mean you have epilepsy. In fact, one in 100 Americans will have an unprovoked seizure in their lifetime. An unprovoked seizure is not necessarily caused by epilepsy. However, two or more unprovoked seizures may signal that you have epilepsy.

The future for epilepsy treatment looks bright. Researchers believe brain stimulation may help patients experience fewer seizures. Small electrodes, placed into your brain, can redirect electrical pulses in the brain and may reduce seizures.

 

 

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