PhD Martijn Drukker V2d - ADHD, Depressie en slaap: Behandeling en

284 Pages·2011·5.79 MB·Dutch

by  Martijn Arns

PERSONALIZED
 MEDICINE
 IN
 ADHD
 AND

DEPRESSION

A
 QUEST
 FOR
 EEG
 TREATMENT
 PREDICTORS

Martijn
 Arns

  2
Cover:

  Mathanje
 Huisman

Printing:
  Ipskamp
 Drukkers,
 Amsterdam

ISBN:

  978-­‐94-­‐6191-­‐098

©
 2011,
 Martijn
 Arns,
 Beek-­‐Ubbergen

  3
PERSONALIZED
 MEDICINE
 IN
 ADHD
 AND

DEPRESSION:

A
 QUEST
 FOR
 EEG
 TREATMENT
 PREDICTORS

EEG
 gebasseerde
 personalisatie
 van
 behandeling
 bij
 Depressie
 en
 ADHD.

(met
 een
 samenvatting
 in
 het
 Nederlands)

Proefschrift

ter
 verkrijging
 van
 de
 graad
 van
 doctor
 aan
 de
 Universiteit
 Utrecht
 op
 gezag
 van
 de
 rector

magnificus,
 prof.
 dr.
 G.J.
 van
 der
 Zwaan,
 ingevolge
 het
 besluit
 van
 het
 college
 voor

promoties
 in
 het
 openbaar
 te
 verdedigen
 op

vrijdag
 23
 december
 2011
 des
 middags
 te
 12.45
 uur

door

Martijn
 Wilco
 Arns

geboren
 op
 4
 december
 1974
 te
 Apeldoorn

4
Promotor:

  Prof.
 dr.
 J.L.
 Kenemans

Co-­‐promotor:
 Dr.
 W.H.I.M.
 Drinkenburg

  5
Table
 of
 contents

Chapter
 1:

  Introduction

Part
 1:
 Treatment
 prediction
 in
 ADHD

Chapter
 2
  EEG
 Phenotypes
 predict
 treatment
 outcome
 to
 stimulants
 in
 children
 with

ADHD

Chapter
 3
  EEG-­‐vigilance
 and
 response
 to
 stimulants
 in
 paediatric
 patients
 with
 Attention

Deficit/Hyperactivity
 Disorder

Chapter
 4
  The
 increase
 in
 theta/beta
 ratio
 on
 resting
 state
 EEG
 in
 boys
 with
 attention-­‐
deficit/hyperactivity
 disorder
 is
 mediated
 by
 slow
 alpha
 peak
 frequency.

Chapter
 5
  Efficacy
 of
 neurofeedback
 treatment
 in
 ADHD:
 The
 effects
 on
 inattention,

impulsivity
 and
 hyperactivity:
 A
 meta-­‐analysis.

Chapter
 6
  The
 effects
 of
 QEEG-­‐informed
 neurofeedback
 in
 ADHD:
 An
 open
 label
 pilot

study.

Part
 2:
 Treatment
 prediction
 in
 depression

Chapter
 7
  An
 investigation
 of
 EEG,
 genetic
 and
 cognitive
 markers
 of
 treatment
 response

to
 antidepressant
 medication
 in
 patients
 with
 major
 depressive
 disorder:
 a

pilot
 study

Suppl.
 1
  EEG
 Phenotypes
 in
 depression

Chapter
 8
  Repetitive
 Transcranial
 Magnetic
 Stimulation
 in
 depression:
 Protocols,

Mechanisms
 and
 New
 Developments

Chapter
 9

  Potential
 differential
 effects
 of
 9
 Hz
 rTMS
 and
 10Hz
 rTMS
 in
 the
 treatment
 of

depression.

Chapter
 10
  Neurophysiological
 predictors
 of
 non-­‐response
 to
 rTMS
 in
 depression

Summary
 and
 conclusions

  References

  Summary
 in
 Dutch
 /
 Samenvatting
 in
 het
 Nederlands

  Acknowledgement
 /
 Dankwoord

  Curriculum
 Vitae

Publications

6
7
Chapter
 1

Introduction

This
 chapter
 is
 adapted
 from
 the
 following
 book
 chapter
 with
 some
 updates
 and
 modifications:

Arns,
 M.,
 Gunkelman,
 J.,
 Olbrich,
 S.,
 Sander,
 C.,
 &
 Hegerl,
 U.
 (2010).
 EEG

vigilance
 and
 phenotypes
 in
 neuropsychiatry:
 Implications
 for
 intervention.
 In

R.
 Coben
 &
 J.
 Evans
 (Eds.),
 Neuromodulation
 and
 neurofeedback:
 Techniques

and
 applications.
 Elsevier.

©
 Copyright
 (2011)
 with
 permission
 from
 Elsevier

8
Introduction

In
 1929
 Hans
 Berger
 reported
 in
 an
 extensive
 publication
 his
 observations
 on
 what
 he

termed
  ‘das
  Elektrenkephalogramm’
  (Berger,
  1929),
  which
  would
  become
  the
  seminal

paper
 highlighting
 the
 beginning
 of
 research
 on
 the
 human
 electroencephalogram
 also

abbreviated
 as
 EEG.
 In
 his
 first
 experiments
 he
 recorded
 the
 EEG
 from
 his
 son
 Klaus
 –
 among

others
 –
 and
 described
 extensively
 the
 methods
 he
 used
 and
 what
 he
 observed.
 Figure
 1

below
 demonstrates
 2
 graphs
 from
 that
 first
 publication
 recorded
 from
 his
 son.
 The
 bottom

figure
 represents
 the
 rhythm
 he
 would
 eventually
 call
 the
 ‘alpha
 EEG
 rhythm’
 and
 the
 top

figure
 represents
 what
 he
 would
 eventually
 call
 the
 ‘beta
 EEG
 rhythm’.
 Since
 that
 time
 much

research
  has
  been
  dedicated
  to
  measuring
  EEG
  under
  different
  conditions
  as
  well
  as

measuring
 EEG
 in
 a
 variety
 of
 disorders
 ranging
 from
 neurological
 to
 psychiatric.

Figure
 1:
 The
 first
 reports
 of
 the
 human
 EEG
 from
 the
 first
 publication
 from
 Hans
 Berger
 (1929).
 Both
 represent

samples
 of
 EEG
 recorded
 from
 his
 son
 Klaus
 (16
 years
 old).
 The
 bottom
 figure
 represents
 a
 sample
 of
 what
 he

would
 later
 call
 the
 ‘alpha
 rhythm’
 (a
 sinusoidal
 rhythm
 of
 approximately
 10
 Hz)
 and
 the
 figure
 above
 what
 he

would
 later
 call
 the
 ‘beta
 rhythm’
 (or
 a
 desynchronized
 EEG
 with
 no
 obvious
 rhythmicity).
 The
 lowest
 tracing
 in

both
 graphs
 is
 a
 generated
 10
 Hz
 sine
 wave,
 and
 the
 middle
 tracing
 from
 the
 top
 figure
 is
 the
 ECG.
 From:

Berger
 (1929).

In
 the
 period
 between
 the
 discovery
 of
 EEG
 in
 1929
 and
 the
 late
 1960’s
 EEG
 was
 mainly

inspected
 visually
 until
 digital
 equipment
 became
 available
 which
 made
 it
 possible
 to
 apply

Fourier
 analysis
 to
 EEG
 data
 to
 extract
 the
 spectral
 content
 –
 or
 frequency
 content
 -­‐
 of
 a

signal.
 This
 eventually
 enabled
 the
 field
 of
 Quantitative
 EEG
 (QEEG)
 as
 we
 know
 it
 today.
 In

the
 simplest
 form
 one
 speaks
 of
 QEEG
 when
 the
 EEG
 is
 submitted
 to
 spectral
 analysis

(Niedermeyer
 &
 Da
 Silva,
 2004).
 In
 this
 respect
 some
 prefer
 to
 speak
 of
 ‘Normative
 EEG’
 to

emphasize
 that
 the
 EEG
 should
 not
 only
 be
 submitted
 to
 spectral
 analysis
 but
 also
 compared

to
 a
 control
 group
 and/or
 normative
 database.

  9
The
 group
 led
 by
 Ross
 Adey
 at
 the
 UCLA
 Brain
 Research
 Institute
 in
 the
 period
 1961-­‐1974

pioneered
 the
 use
 of
 QEEG.
 They
 were
 the
 first
 to
 use
 digital
 computers
 in
 the
 analysis
 of

EEG
 with
 the
 production
 of
 brain
 maps
 and
 developed
 the
 first
 normative
 library
 of
 brain

maps.
 See
 figure
 2
 for
 some
 photos
 with
 the
 first
 equipment
 developed
 to
 measure
 EEG
 in

outer
 space
 and
 during
 driving.
 As
 part
 of
 the
 Space
 Biology
 Laboratory
 they
 studied
 the

effects
 of
 outer
 space
 and
 space
 travel
 on
 the
 brain,
 to
 determine
 whether
 prolonged
 space

flight
 would
 be
 possible
 for
 the
 human
 body.
 As
 part
 of
 this
 NASA
 program
 Graham
 and

Dietlein
 were
 the
 first
 to
 coin
 the
 term
 Normative
 EEG
 (Graham
 &
 Dietlein,
 1965).
 In
 the
 last

20
 years
 due
 to
 the
 increasing
 availability
 of
 affordable
 computer
 equipment
 with
 increasing

calculating
 power,
 the
 field
 of
 QEEG
 has
 expanded
 even
 further
 and
 has
 become
 available

for
  many
  practicing
  clinicians
  and
  clinics.
  Along
  with
  this,
  several
  different
  normative

databases
 have
 been
 developed
 as
 well
 and
 are
 available
 to
 most
 clinicians.

Figure
 2:
 A
 photo
 from
 1963
 showing
 the
 equipment
 developed
 by
 Adey
 et
 al.
 to
 measure
 EEG
 in
 space.
 Ross

Adey
 –
 who
 pioneered
 QEEG
 –
 is
 the
 person
 on
 the
 right
 in
 the
 top
 left
 picture.
 (Courtesy
 of
 the
 Computer

History
 Museum)

In
 this
 thesis
 where
 we
 speak
 of
 QEEG
 we
 focus
 on
 normative
 EEG,
 or
 QEEG
 data
 that
 are

compared
 to
 a
 control
 group
 or
 normative
 database.
 Furthermore,
 we
 will
 restrict
 our
 focus

to
  the
  application
  of
  QEEG
  to
  neuropsychiatric
  conditions,
  whereas
  more
  strictly

10