Friday, January 19, 2024

MENTAL HEALTH

Novel MRI technique improves the lasting effects of treatment for severe depression



Peer-Reviewed Publication

UNIVERSITY OF NOTTINGHAM





A major clinical trial has shown that by using MRI and tracking to guide the delivery of magnetic stimulation to the brains of people with severe depression, patients will see their symptoms ease for at least six months, which could vastly improve their quality of life.

The results of the trial, published in Nature Medicine, found that on average, participants showed substantial improvements in the severity of their depression, anxiety and thinking with better function and quality of life over 26 weeks with MRI neuronavigated Transcranial Magnetic Simulation (TMS). This was a substantial increase on the previous reported improvements lasting only 1-3 months.

The BRIGhTMIND randomised controlled trial was led by experts at the University of Nottingham, hosted by Nottinghamshire Healthcare NHS Foundation Trust, and was funded by a National Institute for Health and Care Research (NIHR) and Medical Research Council (MRC) partnership. It involved five centres across England (Nottingham, Camden and Islington, Newcastle, Northampton and Oldham).

Transcranial Magnetic Simulation (TMS)

TMS is an outpatient treatment where people have powerful magnetic pulses delivered to the left side of their head just in front of the temporal area of the scalp. The person is conscious and has 20 sessions over a four-to-six-week period. The method has been used since the 1980s to treat people with severe depression, but by targeting the precise area of the brain where stimulation is thought to be helpful, we now have evidence for a more longer lasting benefit of this treatment.

Major depression is the leading cause of disability lost years worldwide (WHO, 2017), and suicide from depression is the biggest killer in people aged between 15-49. Antidepressants and therapy delivered as first or second-line treatments help two thirds of people with depression, but the remaining third have treatment resistant depression (TRD). This is defined as a lack of response to two courses of antidepressants.

The aim of the trial was to look at whether the effects of using TMS could be extended to at least six months, which would mean that patients with TRD who respond to the treatment might only require one to two courses of treatment each year to remain relatively well and free from symptoms of depression.

Neuronavigation

The trial, which is the first of its size in the world to look at outcomes at six months, suggest this might be achieved using functional MRI with TMS to define the exact area of the brain to hit. MRI is not normally used to deliver this treatment.

The team used neuronavigation, a computerised tracking system using light to deliver the TMS, which is a way of precisely pinpointing the area of stimulation so that the same area is targeted at all 20 treatment sessions.

Richard Morriss, Professor of Psychiatry in the School of Medicine and Lead for the Centre for Mood Disorders at the Institute of Mental Health at the University of Nottingham, said: “Ideally when people come for a TMS session, they would sit in the exact same place, but this is rarely going to happen. This method uses light from both ear lobes and the top of the nose to measure the stimulation point from the first time a patient has the treatment. The MRI personalises the site of stimulation and then neuronavigation makes sure the same site is being stimulated at each treatment session. This reduces the variability in stimulation at each session. Since the magnetic pulse can be focused, there are usually only minor short-lasting side-effects, and the person can return to their daily activities immediately on return from the hospital.”

A total of 255 participants took part in the trial, all completing 20 TMS sessions. Patients already in specialist mental health services were recruited, and both Primary Care trusts and GPs were approached, with all participants having to be referred by their GP to take part.

Substantial improvement in quality of life

Over two thirds of participants responded to the treatment, with a third showing 50% improvement in terms of their symptoms and a fifth managing to move into remission and stay there.

“Given these patients are people who have not responded to two previous treatment attempts and have been ill for an average of 7 years, to get such a significant response rate and a fifth who have a sustained response is really encouraging,” said Professor Morriss.

He adds: “Patients who responded to the treatment could stay relatively well compared to how they were previously, with as little as one or two treatments a year. The changes we saw were substantial, not only in reducing their depression symptoms, but they were large enough to improve concentration, memory, anxiety and subsequently their quality of life. The results have already persuaded three NHS Mental Health Trusts, including Nottinghamshire Healthcare NHS Foundation Trust, to routinely offer new TMS services for treatment resistant depression.”

One of the participants of the trial said: “It has been a privilege to work alongside the research and clinical teams and feel that you are making an important contribution to such a groundbreaking study from a patient perspective. The next challenge is to make transcranial magnetic stimulation a standard and universally available treatment option for difficult to treat depression." 

Professor Danny McAuley, Scientific Director for NIHR Programmes, said: “Once again, high quality research funded by NIHR and MRC is making a step change in improving health and care services. It’s brilliant to see three UK mental health trusts are now routinely offering TMS to patients following robust evidence from this study.

“These are important findings showing this novel technique can hugely benefit patients with severe depression which has not responded to other treatments."

COVID

FIFA World Cup ends with win for Argentina and COVID-19, new research finds


Peer-Reviewed Publication

YORK UNIVERSITY

Distinguished Research Professor Jianhong Wu 

IMAGE: 

YORK UNIVERSITY FACULTY OF SCIENCE DISTINGUISHED RESEARCH PROFESSOR Jianhong Wu,

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CREDIT: YORK UNIVERSITY





TORONTO, Jan. 18, 2024 – The 2022 FIFA World Cup ended with a tight win for Argentina over France on penalties, but it was also a triumph for SARS-CoV-2 with a significant jump in the number of cases, some of which York University researchers say could have been prevented.

New research published today and led by York used the 2022 FIFA World Cup as a case study to help determine the best ways to mitigate virus spread and hospitalizations at mass gatherings in the future. A technique was used to sample initial conditions stemming from possible matches held between visiting teams, which then formed the basis of independent simulations of each game.

The paper, Modelling disease mitigation at mass gatherings: A case study of COVID-19 at the 2022 FIFA World Cup, was published in the journal PLOS Computational Biology.

Lead author of the paper, York postdoctoral fellow Martin Grunnill, and an academic-industrial collaborative team, including Faculty of Science Distinguished Research Professor Jianhong Wu, found that pre-travel screenings did little to prevent infections and hospitalizations.

Pre-match screening of spectators and match staff, however, with either a rapid antigen test half a day before or with a reverse transcription polymerase chain reaction test one and a half days before a match, was more effective than pre-travel screening. The researchers found doing both pre-travel and pre-match testing had even better outcomes, but what worked best was ensuring all visitors had a COVID-19 vaccination, a second or booster dose, within a few months of departure to the tournament.

“That precaution reduced the rate of infection and particularly the rate of hospitalizations,” says Grunnill.

Prior to the FIFA World Cup, COVID-19 cases and hospitalizations were declining in Qatar but began to rise during the tournament peaking at the beginning of the quarter final.

“The ambitious goal of the partnership research includes developing modelling technologies that can be used to assist in the preparation of major mass gathering events, whether religious or sports related in nature or a major festival,” says Wu. “We hope these platforms can be used to provide input into how to help manage respiratory infection risk for the next FIFA World Cup, hosted by North America, and the Olympic Games in Paris this summer.”

Wu points out that even before COVID-19, large events attracting tens of thousands of people spurred the spread of communicable diseases, sometimes globally.

“In the case of international events like the FIFA World Cup where visitors come from all over the world and return home, there is a higher chance of infections spreading beyond the host country,” says Grunnill.

The work is part of an on-going York-Sanofi collaborative project, funded by the Natural Science and Engineering Research Council of Canada, that aims to developing a generic modelling framework tailored to specific events involving intensive social-economic activities to support preparing those events with minimal risk of disease outbreak and spreading. 

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