Cited by 535Neurological disorders and treatmentsTranscranial Magnetic Stimulation StudiesVagus Nerve Stimulation Research

Closed-loop neuromodulation in an individual with treatment-resistant depression

Open access
Scangos, Katherine W., Khambhati, Ankit N., Daly, Patrick M., Makhoul, Ghassan S., Sugrue, Leo P., Zamanian, Hashem, Liu, Tony X., Rao, Vikram R. +5 more·2021·Nature Medicine

Abstract

Deep brain stimulation is a promising treatment for neuropsychiatric conditions such as major depression. It could be optimized by identifying neural biomarkers that trigger therapy selectively when symptom severity is elevated. We developed an approach that first used multi-day intracranial electrophysiology and focal electrical stimulation to identify a personalized symptom-specific biomarker and a treatment location where stimulation improved symptoms. We then implanted a chronic deep brain sensing and stimulation device and implemented a biomarker-driven closed-loop therapy in an individual with depression. Closed-loop therapy resulted in a rapid and sustained improvement in depression. Future work is required to determine if the results and approach of this n-of-1 study generalize to a broader population. This case report describes a biomarker-driven closed-loop therapy for depression using implanted electrodes to continually sense brain activity and automatically trigger direct brain electrical stimulation in high-depression states.

Integrity signals

Registry

Crossref · 10.1038/s41591-021-01480-w

Cites

38 of 38 references verified0 citation errors · 0 not checkable

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  • Closed-loop DBS was recently piloted in a patient with treatment-resistant depression.

    “Closed-loop DBS was recently piloted in a TRD patient [109].”

    From Deep brain stimulation for depression. (2022) · cites this paper as [109]

  • Responsive VC/VS stimulation triggered by amygdala gamma increases resulted in over 400 daily biomarker detections and acute and sustained remission of depressive symptoms.

    “This strategy resulted in over 400 daily depressive biomarker detections triggering 6-s stimulations, and acute and sustained remission of depressive symptoms.”

    From Deep brain stimulation for depression. (2022) · cites this paper as [109]

  • During 10 days of intracranial mapping, amygdala gamma power correlated with high depressive symptom states measured several times daily.

    “amygdala gamma power correlated with high depressive symptom states measured several times daily.”

    From Deep brain stimulation for depression. (2022) · cites this paper as [109]

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Authors
Scangos, K. W., Khambhati, A. N., Daly, P. M., Makhoul, G. S., Sugrue, L. P., Zamanian, H., Liu, T. X., Rao, V. R., Sellers, K. K., Dawes, H. E., Starr, P. A., Krystal, A. D., & Chang, E. F.
Affiliations
University of California, San Francisco (US)
Corresponding author
Scangos, Katherine W.
Venue
Nature Medicine
Published
2021-10
Volume
27
Issue
10
Pages
1696-1700
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
OpenAlex
W3202708773
Cited by
535
References
38
Citations by year
2026: 108 · 2025: 103 · 2024: 113 · 2023: 136 · 2022: 66 · 2021: 9
FWCI
38.60
Type
journal article
Language
en
Open access
Locations
  • Nature Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • University of California, San Francisco
  • National Institute of Neurological Disorders and Stroke (K23NS110962, UH3NS123310)
Topics
  • Health Sciences › Medicine › Neurology › Neurological disorders and treatments
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
Keywords
closed-loop neuromodulation, deep brain stimulation, treatment-resistant depression, major depressive disorder, neural markers, intracranial electrophysiology, focal electrical stimulation, personalized treatment
MeSH terms
Adult, Brain, Major Depressive Disorder, Electric Stimulation, Female, Humans, Severity of Illness Index, Biomarkers, Treatment Outcome, Deep Brain Stimulation

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