EEG based Personalized Medicine in ADHD and - Brainclinics

138 Pages·2011·14.39 MB·English

by  Martijn Arns

EEG based Personalized Medicine in
ADHD and Depression

Marjn Arns
Director / Researcher
Brainclinics

PhD Candidate Utrecht University

www.brainclinics.com
Why Personalized Medicine
n  What are the real-life effects of:
q  S0mulant medica0on and mul0component behavioral
therapy in ADHD (MTA-trial)
q  An0depressants and CBT in Depression (STAR*D trial)
NIMH-MTA study (Molina et al., 2009)
n  NIMH Collabora0ve Mul0site Mul0modal
Treatment Study of Children with ADHD.
n  N=579 children
n  Random assigment to:
q  14 mo. Medica0on management
q  Mul0component behaviour therapy
q  Combined
q  Usual Community Care
n  8 years follow-up!
NIMH-MTA trial
n  “…no appreciable differences among the children
based on their randomized treatment group
assignment…” (Molina et al., 2009)
n  Subgroup who did improve over 0me (Class 1)
consis0ng of 34% (Swanson et al., 2007)
STAR*D trial (Rush et al., 2006)
n  N=3.671 Depressed
pa0ents
n  Randomized to
different treatments
STAR*D results (Rush et al., 2006)
n  Remission rates: 36.8%
n  Cumula0ve remission rate (4
steps) = 67%
n  1/3rd of all depressed pa0ents
are ‘treatment resistant’.
n  Switch to CBT in Step 2 similar
results albeit slower response
(Thase et al., 2007)
n  Effects of CBT overes0mated
due to ‘publica0on
bias’ (Cuijpers et al., 2010)
Andrew Witty, chief executive of GSK: “we
believe the probability of success is
relatively low, (and) we think the cost of
attaining success is disproportionally
high.” (Miller, 2010).
Personalized Medicine in Psychiatry
n  Efficacy of current pharmaceu0cal treatments seem maximal (AD 40%;
Ritalin 70-90%) and limited (STAR*D & NIMH-MTA)
q  Efficacy of newer drugs (i.e. TCA vs. SSRI) are not drama0cally
improved, mainly improved side effect profile
q  Several pharmaceu0cal companies (GSK, AstraZeneca) will no longer
invest in the development of psychiatric medica0ons (Miller, 2010)
q  Move beyond average efficacy data towards individual treatment!
n  Personalized medicine: Right treatment, for the right person at the right
0me as opposed to ‘Blockbuster’ approach
n  Assumes heterogeneity rather than homogeneity within a psychiatric
disorder!
th
n  10 year anniversary of the Human Genome Project (2011): Implica0ons
for psychiatry?
n  Focus on ‘endophenotypes’ or ‘biomarkers’
n  EEG based predictors for treatment outcome
q  Focus on non-responders (more clinically relevant, no placebo effects
etc.)
What is ‘neuromodula0on’
n  ‘Neuromodulaon is the alteraon of nerve
acvity through the applicaon of electrical
impulses or pharmaceucal agents delivered
directly to a relavely focal brain area. ’
(Harvard Neuromodula0onlab)