Posts Tagged Vagus Nerve Stimulation

[WEB] New treatment approach could be life-changing for many stroke patients

Every year, more than 795,000 people in the United States have a stroke. Of these, approximately 80% lose arm function and as many as 50-60% of this population still experience problems six months later.

Traditionally, stroke patients try to regain motor function through physical rehabilitation, where patients re-learn pre-stroke skills, such as eating motions and grasping. However, most patients eventually plateau and stop improving over time.

Now, results of a clinical trial published in The Lancet gives patients new hope in their recovery.

Patients who received a novel treatment that combines vagus nerve stimulation (VNS) and rehabilitation showed improvement in upper body motor impairment compared to those who received sham (inactive form of) stimulation and rehabilitation. Considered a natural antenna to the brain, the vagus nerve runs from the chest and abdomen to the brainstem and regulates many of the body’s functions.

This is incredibly exciting news for everyone involved in stroke rehabilitation and functional restoration and represents a unique intersection between neurosurgery and neurorehabilitation. These study results are the first of their kind, and open up new possibilities for stroke patients, allowing them to reclaim more arm function even years after having a stroke.”

Charles Liu, MD, PhD, Study Lead Neurosurgeon and Director of Neurorestoration Center of Keck Medicine of University of South California

In this international, multi-center clinical trial, 53 participants with moderate to severe arm weakness nine months to 10 years post-stroke, received rehabilitation paired with VNS. Fifty-five patients within the same parameters received a sham stimulation. The trial was randomized and triple blind.

Those receiving the nerve stimulation had a wire inserted into their neck that wrapped around the vagus nerve. The wire was then connected to a pulse generator device implanted in the chest. Those receiving the sham received placebo implants.

After the surgical procedure, all patients received six weeks of in-clinic therapy, which included tasks such as reaching and grasping, simulated eating and opening and closing containers. After the in-clinic period, patients continued treatment with a course of daily home therapy.

When the two patient groups were compared, those receiving the nerve stimulation scored higher on several standardized measures of upper arm functionality.

“Not only were the results clinically meaningful, the fact that these patients were at least nine months post-stroke and in some instances years out, points to the possibility that meaningful improvements can be achieved even years after a stroke,” said Liu, who also serves as chief of innovation and research and chair of neurosurgery and orthopedics at Rancho Los Amigos National Rehabilitation Center.

The device is thought to work by triggering the release of brain neuromodulators – which regulate the body’s responses – to strengthen motor circuits in the brain associated with movement, enabling the brain to effectively relearn tasks. VNS is already used widely for the treatment of epilepsy and plays an increasing role in the treatment of severe depression.

“For too long, stroke patients have faced limited options for recovery,” said Liu. “This new treatment signifies a breakthrough that could be life-changing for many stroke patients and also represents an approach that will certainly be explored for many other functional restoration applications in the future.”

Source: Keck Medicine of University of South California

Journal reference: Dawson, J., et al. (2021) Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischaemic stroke (VNS-REHAB): a randomised, blinded, pivotal, device trial. The Lancetdoi.org/10.1016/S0140-6736(21)00475-X.

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[WEB] Vagus Nerve Stimulation Improves Arm Function After Stroke

Jessica Nye, PhD

Of the 5 severe events, none were attributed to the trial device; however, many participants in both groups reported postoperative pain after device implantation. Credit: Getty Images

After ischemic stroke, vagus nerve stimulation with rehabilitation is a potential treatment for long-term moderate to severe arm impairment, according to findings of a randomized, triple-blind, sham-controlled study published in The Lancet.

Patients (N=108) with arm impairment after stroke were recruited from 19 sites in the UK and US between 2017 and 2019. Patients were randomly assigned in a 1:1 ratio to receive rehabilitation paired with either active (n=53) or sham (n=55) vagus nerve stimulation.

All participants had a nerve stimulation device implanted. During treatment sessions, all participants received an initial 0.8 mA stimulation that was reduced by 0.1 mA each step. They then completed tasks while they were receiving active or sham stimulation. The active treatment comprised 0.8 mA for 100 ms followed by 30 Hz for 0.5 seconds during each repetition (>300 per session).

Patients in the active and sham groups had a mean age of 59.1±10.2 and 61.1±9.2 years, 64% and 65% were men, and 79% and 78% were White. Stroke had occurred 3.1±2.3 and 3.3±2.6 years previously, paresis was on the left side among 53% and 53%, baseline Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scores were 34.4±8.2 and 35.7±7.8, and Wolf Motor Function Test (WMFT) scores were 2.71±0.70 and 2.83±0.65, respectively.

The first day after treatment, the active group reported an improvement of 2.6 (95% CI, 1.0-4.2; P =.0014) points in FMA-UE scores compared with the sham group. Site location was a significant contributor to these findings (P =.036).

At 90 days, the active treatment group reported an FMA-UE score improvement of 3.0 (95% CI, 0.8-5.1; P =.0077) points compared with the sham group. The change in scores corresponded with 47% of the active and 24% of the sham group reporting a meaningful clinical response (P =.0098).

There was a change from baseline of 0.30 (95% CI, 0.16-0.43; P <.0001) points in WMFT score among the active cohort compared with the sham group at 90 days, in which 57% and 22% had meaningful clinical responses (P <.0001), respectively.

Adverse events were reported by 81% of the active and 76% of sham treatment recipients. Of the 5 severe events, none were attributed to the trial device; however, many participants in both groups reported postoperative pain after device implantation.

The study researchers were not able to determine whether vagus nerve stimulation could be effective for patients with more severe stroke-related symptoms or whether benefits persisted beyond 90 days.

The study authors concluded that vagus nerve stimulation combined with rehabilitation may improve impairment and function. Additional studies are warranted.

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please refer to the original reference for a full list of authors’ disclosures.

Reference

Dawson J, Liu CY, Francisco GE, et al. Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischaemic stroke (VNS-REHAB): a randomised, blinded, pivotal, device trial. Lancet. 2021;397(10284):1545-1553. doi:10.1016/S0140-6736(21)00475-X

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[WEB] Vagus Nerve Stimulation Possible Boost to Post-Stroke Motor Skill Recovery

Posted by Debbie Overman      

Vagus Nerve Stimulation Possible Boost to Post-Stroke Motor Skill Recovery

Pairing vagus nerve stimulation (VNS) with a physical therapy task aimed at improving the function of an upper limb in rodents demonstrated a doubled long-term recovery rate relative to current therapy methods, suggest researchers from The University of Texas at Dallas.

The recovery rate was not only in the performance of the targeted task, but also in similar muscle movements that were not specifically rehabbed, the researchers add in their study, published recently in the journal Stroke.

“Our experiment was designed to ask this new question: After a stroke, do you have to rehabilitate every single action?” says Dr Michael Kilgard, associate director of the Texas Biomedical Device Center (TxBDC) and Margaret Forde Jonsson, professor of Neuroscience in the School of Behavioral and Brain Sciences.

“If VNS helps you, is it only helping with the exact motion or function you paired with stimulation? What we found was that it also improves similar motor skills as well, and that those results were sustained months beyond the completion of VNS-paired therapy.”

“This study tells us that if we use this approach on complicated motor skills, those improvements can filter down to improve simpler movements,” adds Kilgard, in a media release from University of Texas at Dallas.

The vagus nerve controls the parasympathetic nervous system, which oversees elements of many unconscious body functions, including digestion and circulation.

The UT Dallas study’s application of VNS strengthens the communication path to the neurons that are taking over for those damaged by stroke. The experiments showed a threefold-to-fivefold increase in engaged neurons when adding VNS to rehab, the release continues.

“We have long hypothesized that VNS is making new connections in the brain, but nothing was known for sure,” states Dr Seth Hays, the TxBDC director of preclinical research and assistant professor of bioengineering in the Erik Jonsson School of Engineering and Computer Science, part of the research team. “This is the first evidence that we are driving changes in the brain in animals after brain injury. It’s a big step forward in understanding how the therapy works–this reorganization that we predicted would underlie the benefits of VNS.”

The researchers are working on an at-home rehab system targeting the upper limbs, they note in the release.

“We’ve designed a tablet app outlining hand and arm tasks for patients to interact with, delivering VNS as needed,” Meyers shares. “We can very precisely assess their performance and monitor recovery remotely. This is all doable at home.”

[Source(s): University of Texas at Dallas, Science Daily]

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[WEB] Combining VNS and Rehab Suggests Benefits for Stroke Survivors, Per Lancet Study

Combining VNS and Rehab Suggests Benefits for Stroke Survivors, Per Lancet Study

Patients who received a novel treatment that combines vagus nerve stimulation (VNS) and rehabilitation showed improvement in upper body motor impairment compared to those who received a sham (inactive) form of stimulation and rehabilitation, according to results from a study published recently in The Lancet.

“This is incredibly exciting news for everyone involved in stroke rehabilitation and functional restoration and represents a unique intersection between neurosurgery and neurorehabilitation. These study results open up new possibilities for stroke patients, allowing them to reclaim more arm function even years after having a stroke.”  

— Charles Liu, MD, PhD, the lead neurosurgeon of the study and director of the USC Neurorestoration Center of Keck Medicine of USC

VNS Versus Sham Stimulation

In this international, multi-center clinical trial, 53 participants with moderate to severe arm weakness 9 months to 10 years post-stroke received rehabilitation paired with VNS via the Vivistim Paired Vagus Nerve Stimulation System from MicroTransponder Inc, who sponsored the study.

Fifty-five patients within the same parameters received a sham stimulation. The trial was randomized and triple blind.

Those receiving the nerve stimulation had a wire inserted into their neck that wrapped around the vagus nerve. The wire was then connected to a pulse generator device implanted in the chest. Those receiving the sham received placebo implants.

After the surgical procedure, all patients received 6 weeks of in-clinic intense physical therapy, which included tasks such as reaching and grasping, simulated eating and opening and closing containers. After the in-clinic period, patients continued treatment with a course of daily home therapy.

When the two patient groups were compared, those receiving the nerve stimulation scored higher on several standardized measures of upper arm functionality, a media release from Keck Medicine of USC explains.

VNS Trial Data

In a separate release, MicroTransponder Inc shares the following data from the clinical trial:

The multi-center, double-blinded, randomized controlled trial enrolled 108 subjects that were up to 10 years post-stroke with moderate to severe upper extremity impairment. 

Subjects in the study were randomized to either the Paired VNS group (intense physical therapy paired with active VNS) or Control group (intense physical therapy paired with sham VNS) and did 6 weeks of in-clinic therapy followed by 3 months of home-based therapy.

After in-clinic therapy, subjects in the Paired VNS group showed a 5.0 point improvement in the Upper Extremity Fugl-Meyer Assessment compared to 2.4 points in controls (p=0.001). The Wolf Motor Function Test score also improved after Paired VNS compared to controls (0.46 vs 0.16, p<0.0001). After 3 months of home-based therapy, the number of participants achieving a clinically meaningful response in upper limb impairment after Paired VNS was approximately twice that of controls.

The study showed that participants who received Paired VNS had clinically meaningful improvements in both motor impairment and function compared to controls. Improvements with Paired VNS were also observed in quality-of-life measures. There were no unexpected adverse events or serious adverse events associated with the Vivistim System. 

The VNS System

The Vivistim Paired VNS System is designed to stimulate the vagus nerve during task-specific rehabilitation. Stimulation of the vagus nerve triggers release of brain neuromodulators including acetylcholine and norepinephrine that strengthens motor circuits associated with movement, enabling the brain to effectively relearn the task, MicroTransponder Inc explains in its release.

“Not only were the results clinically meaningful, the fact that these patients were at least nine months post-stroke and in some instances years out, points to the possibility that meaningful improvements can be achieved even years after a stroke.

“For too long, stroke patients have faced limited options for recovery. This new treatment signifies a breakthrough that could be life-changing for many stroke patients and also represents an approach that will certainly be explored for many other functional restoration applications in the future.”

— Charles Liu, who also serves as chief of innovation and research and chair of neurosurgery and orthopedics at Rancho Los Amigos National Rehabilitation Center

[Source(s): MicroTransponder Inc, Keck Medicine of USC, PR Newswire, Newswise]

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[Abstract] Vagus nerve stimulation paired with rehabilitation for upper limb motor function after ischaemic stroke (VNS-REHAB): a randomised, blinded, pivotal, device trial

Summary

Background

Long-term loss of arm function after ischaemic stroke is common and might be improved by vagus nerve stimulation paired with rehabilitation. We aimed to determine whether this strategy is a safe and effective treatment for improving arm function after stroke.

Methods

In this pivotal, randomised, triple-blind, sham-controlled trial, done in 19 stroke rehabilitation services in the UK and the USA, participants with moderate-to-severe arm weakness, at least 9 months after ischaemic stroke, were randomly assigned (1:1) to either rehabilitation paired with active vagus nerve stimulation (VNS group) or rehabilitation paired with sham stimulation (control group). Randomisation was done by ResearchPoint Global (Austin, TX, USA) using SAS PROC PLAN (SAS Institute Software, Cary, NC, USA), with stratification by region (USA vs UK), age (≤30 years vs >30 years), and baseline Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score (20–35 vs 36–50). Participants, outcomes assessors, and treating therapists were masked to group assignment. All participants were implanted with a vagus nerve stimulation device. The VNS group received 0·8 mA, 100 μs, 30 Hz stimulation pulses, lasting 0·5 s. The control group received 0 mA pulses. Participants received 6 weeks of in-clinic therapy (three times per week; total of 18 sessions) followed by a home exercise programme. The primary outcome was the change in impairment measured by the FMA-UE score on the first day after completion of in-clinic therapy. FMA-UE response rates were also assessed at 90 days after in-clinic therapy (secondary endpoint). All analyses were by intention to treat. This trial is registered at ClinicalTrials.govNCT03131960.

Findings

Between Oct 2, 2017, and Sept 12, 2019, 108 participants were randomly assigned to treatment (53 to the VNS group and 55 to the control group). 106 completed the study (one patient for each group did not complete the study). On the first day after completion of in-clinic therapy, the mean FMA-UE score increased by 5·0 points (SD 4·4) in the VNS group and by 2·4 points (3·8) in the control group (between group difference 2·6, 95% CI 1·0–4·2, p=0·0014). 90 days after in-clinic therapy, a clinically meaningful response on the FMA-UE score was achieved in 23 (47%) of 53 patients in the VNS group versus 13 (24%) of 55 patients in the control group (between group difference 24%, 6–41; p=0·0098). There was one serious adverse event related to surgery (vocal cord paresis) in the control group.

Interpretation

Vagus nerve stimulation paired with rehabilitation is a novel potential treatment option for people with long-term moderate-to-severe arm impairment after ischaemic stroke.

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[WEB] NEW STROKE REHABILITATION SYSTEM PROVEN TO WORK IN IMPAIRED STROKE PATIENTS

By Iednewsdesk

A stroke rehabilitation system, developed by MicroTransponder Inc and studied by a team at the University of Glasgow, has been shown to significantly improve arm impairment and function in people with long-term arm weakness after ischaemic stroke.

Long-term loss of arm function after ischaemic stroke is common, and the results of the study – published today in The Lancet – showed two to three times greater improvement with Vagus Nerve Stimulation (VNS) when it was combined with intense physical therapy, compared to intense physical therapy alone.

Strokesign

Approximately 80% of people with acute stroke have arm weakness, and as many as 50%-60% still have persistent problems six months later. There are currently few effective treatments to enhance arm recovery after stroke, and intense physical therapy is currently the best treatment option.

In the study – which looked at 108 people in the United States and the United Kingdom with moderate to severe arm problems – trial participants were randomised to intense physical therapy paired with active VNS or intense physical therapy paired with sham VNS (Control group).

VNS involves implant surgery, a bit like a cardiac pacemaker. Once implanted, the device stimulates the vagus nerve on the left side of the neck during intensive task-specific rehabilitation. The vagus nerve connects with areas of the brain that cause release of important neuromodulators or chemicals which, when combined with physical therapy, helps the brain ’re-learn’ movements.

After 6 weeks of out-patient therapy and a further ninety days of home based therapy, 47% of the people in the VNS group showed a clinically meaningful response versus 24% in the control group. People who received VNS also showed improvement over the control group in quality of life and activity measures.

Jesse Dawson, Professor of Stroke Medicine, at the University of Glasgow and principal investigator of the trial, said: “This is the first study to find clinically- and statistically-significant effects of a neuromodulation therapy for people with arm and hand weakness after chronic stroke.

“We saw improvement for the VNS group in both impairment and functional measures compared to Controls. In particular, the clinically meaningful response rate doubled with VNS for both impairment and functional outcomes. Importantly, the VNS doesn’t work alone – it adds to the effect of intensive rehabilitation”

Dr. Teresa Kimberley, PhD, PT, Professor and Director of the Brain Recovery Lab at MGH Institute of Health Professions, a senior investigator on the project through both the pilot and pivotal studies, added: “The results of this clinical study suggest that the addition of VNS enhances the effect of best practice stroke rehabilitation

“We are looking forward to potentially establishing the therapy as part a new standard of care for stroke rehabilitation. “

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[WEB] Revolutionary neck implant that zaps stroke patients’ NERVES could help them to regain hand movements

  • Stroke rehabilitation system developed by MicroTransponder based in Texas  
  • ‘Vivistim’ device is inserted with a small incision under anaesthesia in the neck
  • Researchers reveal it improves arm function for people after ischaemic stroke

By JONATHAN CHADWICK FOR MAILONLINE 

A matchbox-sized neck implant that delivers stimulating bursts of electricity could help stroke patients regain hand movements, scientists claim.  

The ‘Vivistim’ device, from Texas-based biotech firm MicroTransponder, stimulates the vagus nerve – a large nerve running from the head and neck to the abdomen. 

Vivistim stimulates the vagus nerve while the patient is undergoing rehabilitative movement, which tells the brain to ‘pay attention’ to that movement. 

Newly-published research reveals Vivistim significantly improves arm impairment and function in people with long-term arm weakness after ischaemic stroke. 

Vagus nerve stimulation (VNS) has in the past been explored as a way of treating depression, epilepsy, tinnitus, stroke, heart conditions and obesity.   

The vagus nerve is a large nerve running from the head and neck to the abdomen. Top left is the small implant developed by MicroTransponder
The vagus nerve is a large nerve running from the head and neck to the abdomen. Top left is the small implant developed by MicroTransponder

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HOW DOES IT WORK? 

1. Implanted lead delivers bursts of electricity to the Vagus nerve that travel up to the brain. 

2. The electric signal passes through the nucleus tractus solitarius, or NTS (cell bodies found in the brainstem) to two distinct brain regions. 

3. When these regions receive the electric signal, they release neuromodulators (brain chemicals). 

4. The release of neuromodulators increases the ‘relevance’ of physical therapy performed by the patient. 

5. This simultaneous pairing of muscle movement with VNS strengthens the neural circuits in the brain, and, over time, a patient may regain upper limb function.     

—————————

VNS involves implant surgery, a bit like a cardiac pacemaker. 

The implant is inserted into patients under general anaesthesia via a horizontal neck incision around the cricoid cartilage – the ring of cartilage that surrounds the trachea. 

Once implanted, the device stimulates the vagus nerve on the left side of the neck during intensive physical rehabilitation. 

The electrical pulse from Vivistim feels at most like a ‘transient tingle in throat’ that wears off oversee time. 

The vagus nerve – named after the the Latin for ‘wandering’ – is the longest nerve running from the brain to the body, and it has many branches that veer off into the brain’s regions. 

The vagus nerve connects with areas of the brain that cause release of important chemicals which, when combined with physical therapy, help the brain ‘re-learn’ movements.

The safety of VNS implants has been well established in other clinical areas, according to the team.  

‘VNS implant procedures have been performed for over 20 years and are generally simple and straightforward,’ said study author Dr Charles Liu, director of the USC Neurorestoration Center in California.

‘We’re excited by the prospect of safe and established surgical procedures that may help restore hand and arm function after stroke.’          

Long-term loss of arm function is common after ischaemic stroke – the most common type of stroke, associated with a blockage of blood flow to the brain. 

[…]

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[WEB] New device to help impaired stroke patients improve arm function.

By Maja Grantham

A NEW device is lending hope to stroke patients with arm and hand problems as a new device is being hailed as being able to improve arm impairment and function. 

The device, the Vagus Nerve Stimulation (VNS) was developed by MicroTransponder, a medical device company and  studied by a team at the University of Glasgow.

A study published in The Lancet found that physiotherapy combined with the VNS showed more than double the improvement of physiotherapy alone.

The University of Glasgow - Health News Scotland
After being studied at the University of Glasgow, the VNS device has been proven to have good results. Photo by Johnny Briggs on Unsplash.

The VNS “has been shown to significantly improve arm impairment and function in people with long-term arm weakness after ischaemic stroke.” According to the University of Glasgow.

This study looked at 108 people with moderate to severe arm problems from the UK and the USA.

After six weeks, nearly half of the people who got the VNS implant showed a “clinically meaningful response” compared to only 24% in the control group.

A researcher -Health News Scotland
Research at the University has shown that the VNS has helped stroke patients regain strength in their arms. Photo by National Cancer Institute on Unsplash.

Jesse Dawson, a professor of stroke medicine at the University of Glasgow said:  “This is the first study to find clinically- and statistically-significant effects of a neuromodulation therapy for people with arm and hand weakness after chronic stroke.

“We saw improvement for the VNS group in both impairment and functional measures compared to Controls. In particular, the clinically meaningful response rate doubled with VNS for both impairment and functional outcomes. Importantly, the VNS doesn’t work alone – it adds to the effect of intensive rehabilitation”  

The control group had surgery to implant a false VNS and did physiotherapy. The group with the real VNS system did the same physiotherapy but they got a real VNS implant.

Dr. Teresa Kimberley, a senior investigator on the project said: “The results of this clinical study suggest that the addition of VNS enhances the effect of best practice stroke rehabilitation

“We are looking forward to potentially establishing the therapy as part a new standard of care for stroke rehabilitation.“

Approximately 80% of people who have a stroke suffer from arm weakness, 50% to 60% still have this problem 6 months after their stroke.

The VNS involves surgery to implant the device, once implanted the device stimulates specific nerves during intensive task-specific rehabilitation.

Efforts are currently underway to try to gain marketing authorisation from US and EU regulatory bodies.

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[Slideshow] Depression Overview: Emotional Symptoms, Physical Signs, and More

Δημιουργήθηκε απόσπασμα από: https://www.webmd.com/depression/ss/slideshow-depression-overview

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Depression: What Is It?

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It’s natural to feel down sometimes, but if that low mood lingers day after day, it could signal depression. Major depression is an episode of sadness or apathy along with other symptoms that lasts at least two consecutive weeks and is severe enough to interrupt daily activities. Depression is not a sign of weakness or a negative personality. It is a major public health problem and a treatable medical condition.

Shown here are PET scans of the brain showing different activity levels in a person with depression, compared to a person without depression.

Depression Symptoms: Emotional

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The primary symptoms of depression are a sad mood and/or loss of interest in life. Activities that were once pleasurable lose their appeal. Patients may also be haunted by a sense of guilt or worthlessness, lack of hope, and recurring thoughts of death or suicide.

Depression Symptoms: Physical

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Depression is sometimes linked to physical symptoms. These include:

  • Fatigue and decreased energy
  • Insomnia, especially early-morning waking
  • Excessive sleep
  • Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment

Depression can make other health problems feel worse, particularly chronic pain. Key brain chemicals influence both mood and pain. Treating depression has been shown to improve co-existing illnesses.

Depression Symptom: Appetite

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Changes in appetite or weight are another hallmark of depression. Some patients develop increased appetite, while others lose their appetite altogether. Depressed people may experience serious weight loss or weight gain.

Impact on Daily Life

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Without treatment, the physical and emotional turmoil brought on by depression can derail careers, hobbies, and relationships. People with depression often find it difficult to concentrate and make decisions. They turn away from previously enjoyable activities, including sex. In severe cases, depression can become life-threatening.

Suicide Warning Signs

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People who are depressed are more likely to attempt suicide. Warning signs include talking about death or suicide, threatening to hurt people, or engaging in aggressive or risky behavior. Anyone who appears suicidal should be taken very seriously. Do not hesitate to call one of the suicide hotlines: 800-SUICIDE (800-784-2433) and 800-273-TALK (800-273-8255). If you have a plan to commit suicide, go to the emergency room for immediate treatment.

Depression: Who’s at Risk?

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Anyone can become depressed, but many experts believe genetics play a role. Having a parent or sibling with depression increases your risk of developing the disorder. Women are twice as likely as men to become depressed.

Causes of Depression

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Doctors aren’t sure what causes depression, but a prominent theory is altered brain structure and chemical function. Brain circuits that regulate mood may work less efficiently during depression. Drugs that treat depression are believed to improve communication between nerve cells, making them run more normally. Experts also think that while stress — such as losing a loved one — can trigger depression, one must first be biologically prone to develop the disorder. Other triggers could include certain medications, alcohol or substance abuse, hormonal changes, or even the season.

Illustrated here are neurons (nerve cells) in the brain communicating via neurotransmitters.

Seasonal Depression

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If your mood matches the season — sunny in the summer, gloomy in the winter — you may have a form of depression called seasonal affective disorder (SAD). The onset of SAD usually occurs in the late fall and early winter, as the daylight hours grow shorter. Experts say SAD affects from 3% to 20% of all people, depending upon where they live.

Postpartum Depression

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The “baby blues” strikes as many as three out of four new mothers. But nearly 12% develop a more intense dark mood that lingers even as their baby thrives. This is known as postpartum depression, and the symptoms are the same as those of major depression. An important difference is that the baby’s well-being is also at stake. A depressed mother may have trouble enjoying and bonding with their infant.

  

Depression in Children

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In the United States, depression affects 2% of grade school kids and about one in 10 teenagers. It interferes with the ability to play, make friends, and complete schoolwork. Symptoms are similar to depression in adults, but some children may appear angry or engage in risky behavior, called “acting out.” Depression can be difficult to diagnose in children.
  

Diagnosing Depression

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As of yet, there is no lab test for depression. To make an accurate diagnosis, doctors rely on a patient’s description of the symptoms. You’ll be asked about your medical history and medication use since these may contribute to symptoms of depression. Discussing moods, behaviors, and daily activities can help reveal the severity and type of depression. This is a critical step in determining the most effective treatment.

Talk Therapy for Depression

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Studies suggest different types of talk therapy can fight mild to moderate depression. Cognitive behavioral therapy aims to change thoughts and behaviors that contribute to depression. Interpersonal therapy identifies how your relationships impact your mood. Psychodynamic psychotherapy helps people understand how their behavior and mood are affected by unresolved issues and unconscious feelings. Some patients find a few months of therapy are all they need, while others continue long term.

Medications for Depression

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Antidepressants affect the levels of brain chemicals, such as serotonin and norepinephrine. There are many options. Give antidepressants a few weeks of use to take effect. Good follow-up with your doctor is important to evaluate their effectiveness and make dosage adjustments. If the first medication tried doesn’t help, there’s a good chance another will. The combination of talk therapy and medication appears particularly effective.

Exercise for Depression

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Research suggests exercise is a potent weapon against mild to moderate depression. Physical activity releases endorphins that can help boost mood. Regular exercise is also linked to higher self-esteem, better sleep, less stress, and more energy. Any type of moderate activity, from swimming to housework, can help. Choose something you enjoy and aim for 20 to 30 minutes four or five times a week.

Light Therapy (Phototherapy)

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Light therapy has shown promise as an effective treatment not only for SAD but for some other types of depression as well. It involves sitting in front of a specially designed light box that provides either a bright or dim light for a prescribed amount of time each day. Light therapy may be used in conjunction with other treatments. Talk to your doctor about getting a light box and the recommended length of time for its use.

St. John’s Wort for Depression

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St. John’s wort is an herbal supplement that has been the subject of extensive debate. There is some evidence that it can fight mild depression, but two large studies have shown it is ineffective against moderately severe major depression. St. John’s wort can interact with other medications you may be taking for medical conditions or birth control. Talk to your doctor before taking this or any other supplement.  

Pets for Depression

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A playful puppy or wise-mouthed parrot is no substitute for medication or talk therapy. But researchers say pets can ease the symptoms of mild to moderate depression in many people. Pets provide unconditional love, relieve loneliness, and give patients a sense of purpose. Studies have found pet owners have less trouble sleeping and better overall health.

The Role of Social Support

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Because loneliness goes hand-in-hand with depression, developing a social support network can be an important part of treatment. This may include joining a support group, finding an online support community, or making a genuine effort to see friends and family more often. Even joining a book club or taking classes at your gym can help you connect with people on a regular basis.

Vagus Nerve Stimulation (VNS)

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Vagus nerve stimulation (VNS) may help patients with treatment-resistant depression that does not improve with medication. VNS is like a pacemaker for the brain. The surgically implanted device sends electrical pulses to the brain through the vagus nerve in the neck. These pulses are believed to ease depression by affecting mood areas of the brain.
  

Electroconvulsive Therapy (ECT)

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Another option for patients with treatment-resistant or severe melancholic depression is electroconvulsive therapy (ECT). This treatment uses electric charges to create a controlled seizure. Patients are not conscious for the procedure. ECT helps 80% to 90% of patients who receive it, giving new hope to those who don’t improve with medication.

Transcranial Magnetic Stimulation

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A newer option for people with stubborn depression is repetitive transcranial magnetic stimulation (rTMS). This treatment aims electromagnetic pulses at the skull. It stimulates a tiny electrical current in a part of the brain linked to depression. rTMS does not cause a seizure and appears to have few side effects. But doctors are still fine-tuning this treatment.

Good Outlook

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In the midst of major depression, you may feel hopeless and helpless. But the fact is, this condition is highly treatable. More than 80% of people get better with medication, talk therapy, or a combination of the two. Even when these therapies fail to help, there are cutting-edge treatments that pick up the slack.

Sources Reviewed by Melinda Ratini, DO, MS on August 06, 2020

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SOURCES:
 Barkham, M. British Medical Bulletin, 2001.

 Gjerdinjen, D. Journal of the American Board of Family Medicine, 2007.

 Harvard Health Publications: “Exercise and Depression.”

 Johns Hopkins Health Alerts: “The Many Benefits of Pets.”

 Johns Hopkins Medicine: “Seasonal Affective Disorder.”

 Mental Health America: “Co-occuring Disorders and Depression.”

 National Institute of Mental Health, National Institutes of Health: “How is depression diagnosed and treated?” “What causes depression?” “What are the signs and symptoms of depression?” “What illnesses often co-exist with depression?” “Magnetic Stimulation Scores Modest Success as Antidepressant,” “Major Depressive Disorder in Children.”

 The Merck Manual: “Depression.”

This tool does not provide medical advice. See additional information.

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[ARTICLE] Baseline Motor Impairment Predicts Transcranial Direct Current Stimulation Combined with Physical Therapy-Induced Improvement in Individuals with Chronic Stroke – Full Text

Abstract

Transcranial direct current stimulation (tDCS) can enhance the effect of conventional therapies in post-stroke neurorehabilitation. The ability to predict an individual’s potential for tDCS-induced recovery may permit rehabilitation providers to make rational decisions about who will be a good candidate for tDCS therapy. We investigated the clinical and biological characteristics which might predict tDCS plus physical therapy effects on upper limb motor recovery in chronic stroke patients. A cohort of 80 chronic stroke individuals underwent ten to fifteen sessions of tDCS plus physical therapy. The sensorimotor function of the upper limb was assessed by means of the upper extremity section of the Fugl-Meyer scale (UE-FM), before and after treatment. A backward stepwise regression was used to assess the effect of age, sex, time since stroke, brain lesion side, and basal level of motor function on UE-FM improvement after treatment. Following the intervention, UE-FM significantly improved (), and the magnitude of the change was clinically important (mean 6.2 points, 95% CI: 5.2–7.4). The baseline level of UE-FM was the only significant predictor (, , ) of tDCS response. These findings may help to guide clinical decisions according to the profile of each patient. Future studies should investigate whether stroke severity affects the effectiveness of tDCS combined with physical therapy.

1. Introduction

Transcranial direct current stimulation (tDCS) is an emerging technique with the potential to enhance the effect of therapeutic approaches in post-stroke rehabilitation [12]. According to the interhemispheric competition model [34], anodal tDCS is applied to increase the excitability of the lesioned hemisphere. In contrast, cathodal tDCS is applied to decrease the excitability of the nonlesioned hemisphere. Lastly, bihemispheric tDCS involves anodal and cathodal tDCS applied simultaneously [5].

Regarding the effects of each tDCS method, it is suggested that bihemispheric tDCS has a more significant effect on chronic stroke [68]. Moreover, the positive effect of each tDCS approach on stroke motor recovery has been elucidated by previous studies [913]. Notably, recent systematic reviews reported the improvement of upper limb (UL) sensorimotor functions and improvement of activities of daily living following tDCS in post-stroke individuals [81014].

Despite its great potential, post-stroke subjects show different responses to tDCS. Furthermore, the variability of tDCS effectiveness limits its implementation as standard patient care [15]. A better understating of individual characteristics for predicting motor recovery in responding to treatment should be considered a crucial component for post-stroke rehabilitation.

Following a stroke, neural reorganization, due to spontaneous recovery or induced by therapeutic interventions, is influenced by clinical and biological factors [1618]. Some of these factors might help to predict therapy-mediated motor recovery [1821], i.e., stroke chronicity [2223], sex [2425], age [2326], prestroke hemispheric dominance [18], and time since stroke [17].

Initial motor impairment can also predict motor outcomes [27]. Post-stroke motor recovery is highly variable [15], and individuals could present mild to severe motor impairment [28]. Overall, the initial (i.e., baseline) motor impairment is a strong predictor of functional improvement; e.g., moderate motor impairment is associated with better recovery than severe impairment in post-stroke survivors [29].

Notably, previous studies employing tDCS combined with physical therapy included patients with different motor impairment levels and reported heterogeneous results [3032]. The variability of tDCS response could be related to different aspects related to the technique or the patient’s characteristics. Regarding the tDCS, the parameters of the technique, the ideal number of sessions, and the most appropriate stimulation site (lesioned hemisphere, nonlesioned hemisphere, or both hemispheres) should be considered. Concerning the post-stroke individuals, it is important to consider the motor impairment, the location and size of the lesion, and the previous condition of the subject. The most appropriate supporting therapy should also be considered. The heterogeneous results could be related to one or more of these factors (reviewed in Simonetta-Moreau [33]).

Considering predictive factors that might guide stroke recovery, recent studies suggest the development of algorithms or models to determine functional recovery following rehabilitation in either acute or chronic post-stroke individuals [534]. Although there is an increasing number of studies using tDCS in stroke rehabilitation and its relevance for clinical practice, it is unknown whether personal factors, e.g., age and sex, may predict the magnitude of the effect of tDCS on functional recovery [33]. Moreover, UL sensorimotor impairments (e.g., disrupted interjoint coordination, spasticity, and loss of dexterity) are common after stroke and persist in the chronic stage [3536]. These deficits may lead to decreased quality of life and social participation. Thus, this study was aimed at investigating if clinical and biological characteristics might predict the tDCS plus physical therapy effects on UL motor recovery in chronic stroke individuals. This knowledge might help to guide clinical decisions according to the clinical profile of each patient as well as to enhance clinical evidence-based practice for neurorehabilitation.[…]

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