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Deep Brain Stimulation of the Bilateral Habenula for Treatment-Refractory Obsessive-Compulsive Disorder

Primary Purpose

Obsessive-Compulsive Disorder

Status
Unknown status
Phase
Not Applicable
Locations
China
Study Type
Interventional
Intervention
Bilateral surgical implantation of DBS system to habenula
Sponsored by
Ruijin Hospital
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Obsessive-Compulsive Disorder focused on measuring Habenula, Obsessive-Compulsive Disorder, Deep brain stimulation

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Diagnosed as having primary OCD according to DSM-IV criteria using the Structured Clinical Interview for DSM-IV Axis I disorders;
  • YBOCSII score ≥31;
  • Duration ≥2 years;
  • Refractoriness to therapy was defined as no response or insufficient response following at least 2 treatments with adequate trials or intolerance to two or three selective serotonin transporter inhibitors (SSRIs) and clomipramine, augmentation strategies (antipsychotics) and cognitive behavioral therapy.
  • Capacity to provide informed consent (understanding of the study purpose and methods.

Exclusion Criteria:

  • Except for those with major depressive disorder and mild anxiety disorders, patients with clinically significant comorbid DSM-IV diagnoses (such as schizophrenia, bipolar II disorder, alcohol or substance abuse in the last 6 months, current tic disorder, or body dysmorphic disorder)
  • Patients with severe personality disorders, assessed using the Structured Clinical Interview for DSM-IV Axis II disorders.
  • Serious and unstable organic diseases (e.g. unstable coronal heart disease);
  • Pregnancy and/or lactation.

Sites / Locations

  • Shanghai Ruijin Hospital Functional NeurosurgeryRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

DBS

Arm Description

All subjects will undergo bilateral surgical implantation of DBS system to habenula. The DBS system will be active at one week after surgery.

Outcomes

Primary Outcome Measures

Change in Y-BOCSII Score
The score of the scale ranges from 0 to 50
Change in OCI-R Score
The score of the scale ranges from 0 to 72

Secondary Outcome Measures

changes in the Hamilton Depression Scale(HAMD-17)
The score of the scale ranges from 0 to 50
changes in the Hamilton Anxiety Scale(HAMA-14)
The score of the scale ranges from 0 to 56
changes in FMRI signal
The FMRI signal is to estimate Blood Oxygenation Level Dependent (BOLD) and connectivity of brain areas
changes in World Health Organization Quality of Life-BREF(WHO-BREF)
changes the MOS item short from health survey (SF-36)
Neuropsychological measures(Scores of cogstate battery)
Neuropsychological measures contains six tasks which are detection task, identification task, one card learning task, one back task, Groton maze learning task, set-shifting task

Full Information

First Posted
February 28, 2018
Last Updated
March 27, 2018
Sponsor
Ruijin Hospital
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1. Study Identification

Unique Protocol Identification Number
NCT03463590
Brief Title
Deep Brain Stimulation of the Bilateral Habenula for Treatment-Refractory Obsessive-Compulsive Disorder
Official Title
Deep Brain Stimulation of the Bilateral Habenula for Treatment-Refractory Obsessive-Compulsive Disorder
Study Type
Interventional

2. Study Status

Record Verification Date
March 2018
Overall Recruitment Status
Unknown status
Study Start Date
March 1, 2018 (Actual)
Primary Completion Date
February 28, 2020 (Anticipated)
Study Completion Date
February 28, 2020 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Ruijin Hospital

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
Deep brain stimulation (DBS) offers an effective and safe treatment for patients with debilitating, otherwise treatment-refractory obsessive-compulsive disorder(OCD). Although several target areas for DBS have been used for OCD, such as the ventral capsule/ventral striatum and the subthalamic nucleus, not all patients show a clinical response, varying from 10% to 61.5%. Exploring new DBS targets may be a key approach to improve this situation. The habenula is an evolutionarily conserved structure playing an important role in depression, punishment avoiding, reward, addiction, pain and circadian rhythms. The habenula can be considered a promising target for OCD treatment based on the following hypotheses and clinical observations. The lateral habenula DBS has significant clinical antidepressant effects. The habenula plays an important role in the regulation of dopamine and serotonin systems. Selective serotonin reuptake inhibitors, the first line treatment for OCD, are commonly used to treat clinical depression. The habenula serves as a 'negative reward center' that mediates or moderates stress, negative emotions and thoughts, aversive learning, and goal-directed behavior, which are core clinical symptoms and signs of OCD. In our hospital, DBS of the habenula produced a significant improvement in OCD symptoms in one patient who failed to respond to other treatments, including capsulotomy either alone or in combination combined with cingulumotomy. These theoretical and clinical considerations indicate that the habenula can be seen as a promising DBS target for OCD treatment. This study is focused on the effectiveness of bilateral DBS of the habenula for patients with treatment-refractory OCD. Furthermore, the study is aimed at exploring the influence of DBS of the habenula on brain activity and cognition.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Obsessive-Compulsive Disorder
Keywords
Habenula, Obsessive-Compulsive Disorder, Deep brain stimulation

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Single Group Assignment
Model Description
All subjects will receive bilateral surgical implantation of DBS system
Masking
None (Open Label)
Allocation
N/A
Enrollment
6 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
DBS
Arm Type
Experimental
Arm Description
All subjects will undergo bilateral surgical implantation of DBS system to habenula. The DBS system will be active at one week after surgery.
Intervention Type
Device
Intervention Name(s)
Bilateral surgical implantation of DBS system to habenula
Intervention Description
The DBS device utilized in the present study may include the Medtronic, PINS and SceneRay DBS device depending on patients' choice.
Primary Outcome Measure Information:
Title
Change in Y-BOCSII Score
Description
The score of the scale ranges from 0 to 50
Time Frame
Baseline (preoperative),1 month, 3 months,6 months, 9 months
Title
Change in OCI-R Score
Description
The score of the scale ranges from 0 to 72
Time Frame
Baseline (preoperative),1 month, 3 months,6 months, 9 months
Secondary Outcome Measure Information:
Title
changes in the Hamilton Depression Scale(HAMD-17)
Description
The score of the scale ranges from 0 to 50
Time Frame
Baseline(preoperative),1 month, 3 months, 6 months,9 months
Title
changes in the Hamilton Anxiety Scale(HAMA-14)
Description
The score of the scale ranges from 0 to 56
Time Frame
Baseline(preoperative),1 month, 3 months, 6 months,9 months
Title
changes in FMRI signal
Description
The FMRI signal is to estimate Blood Oxygenation Level Dependent (BOLD) and connectivity of brain areas
Time Frame
Baseline(preoperative),3 month, 6 months, 9 months
Title
changes in World Health Organization Quality of Life-BREF(WHO-BREF)
Time Frame
Baseline(preoperative),1 month, 3 months,6 months,9 months
Title
changes the MOS item short from health survey (SF-36)
Time Frame
Baseline(preoperative),1 month, 3 months,6 months,9 months
Title
Neuropsychological measures(Scores of cogstate battery)
Description
Neuropsychological measures contains six tasks which are detection task, identification task, one card learning task, one back task, Groton maze learning task, set-shifting task
Time Frame
Baseline(preoperative),1 month, 3months,6months,9months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
65 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Diagnosed as having primary OCD according to DSM-IV criteria using the Structured Clinical Interview for DSM-IV Axis I disorders; YBOCSII score ≥31; Duration ≥2 years; Refractoriness to therapy was defined as no response or insufficient response following at least 2 treatments with adequate trials or intolerance to two or three selective serotonin transporter inhibitors (SSRIs) and clomipramine, augmentation strategies (antipsychotics) and cognitive behavioral therapy. Capacity to provide informed consent (understanding of the study purpose and methods. Exclusion Criteria: Except for those with major depressive disorder and mild anxiety disorders, patients with clinically significant comorbid DSM-IV diagnoses (such as schizophrenia, bipolar II disorder, alcohol or substance abuse in the last 6 months, current tic disorder, or body dysmorphic disorder) Patients with severe personality disorders, assessed using the Structured Clinical Interview for DSM-IV Axis II disorders. Serious and unstable organic diseases (e.g. unstable coronal heart disease); Pregnancy and/or lactation.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Yingying Zhang, MSc
Phone
+086-17602137369
Email
zhyy019@126.com
Facility Information:
Facility Name
Shanghai Ruijin Hospital Functional Neurosurgery
City
Shanghai
State/Province
Shanghai
ZIP/Postal Code
200025
Country
China
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Chencheng Zhang, MD
Phone
+086-18217122884
Email
i@cczhang.org
First Name & Middle Initial & Last Name & Degree
Yingying Zhang, MSc
Phone
+086-17602137369
Email
zhyy019@126.com

12. IPD Sharing Statement

Citations:
PubMed Identifier
26208305
Citation
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Results Reference
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PubMed Identifier
29406245
Citation
Kohl S, Baldermann JC. Progress and challenges in deep brain stimulation for obsessive-compulsive disorder. Pharmacol Ther. 2018 Jun;186:168-175. doi: 10.1016/j.pharmthera.2018.01.011. Epub 2018 Jan 31.
Results Reference
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PubMed Identifier
28384832
Citation
Hirschtritt ME, Bloch MH, Mathews CA. Obsessive-Compulsive Disorder: Advances in Diagnosis and Treatment. JAMA. 2017 Apr 4;317(13):1358-1367. doi: 10.1001/jama.2017.2200.
Results Reference
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PubMed Identifier
28576510
Citation
Batalla A, Homberg JR, Lipina TV, Sescousse G, Luijten M, Ivanova SA, Schellekens AFA, Loonen AJM. The role of the habenula in the transition from reward to misery in substance use and mood disorders. Neurosci Biobehav Rev. 2017 Sep;80:276-285. doi: 10.1016/j.neubiorev.2017.03.019. Epub 2017 May 30.
Results Reference
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PubMed Identifier
28223096
Citation
Fakhoury M. The habenula in psychiatric disorders: More than three decades of translational investigation. Neurosci Biobehav Rev. 2017 Dec;83:721-735. doi: 10.1016/j.neubiorev.2017.02.010. Epub 2017 Feb 13.
Results Reference
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PubMed Identifier
25476971
Citation
Antolin-Fontes B, Ables JL, Gorlich A, Ibanez-Tallon I. The habenulo-interpeduncular pathway in nicotine aversion and withdrawal. Neuropharmacology. 2015 Sep;96(Pt B):213-22. doi: 10.1016/j.neuropharm.2014.11.019. Epub 2014 Dec 2.
Results Reference
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PubMed Identifier
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Citation
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Results Reference
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Deep Brain Stimulation of the Bilateral Habenula for Treatment-Refractory Obsessive-Compulsive Disorder

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