SUMMARY: Background: Zolpidem, a selective GABA agonist at the GABA(A)-alpha1-receptor subunit, may restore consciousness and other cognitive functions ...
SYLLABUS & PROCEEDINGS
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SUMMARY: Background: Zolpidem, a selective GABA agonist at the GABA(A)-alpha1-receptor subunit, may restore consciousness and other cognitive functions in a minority of brain damaged subjects. The response to zolpidem may be predicted by baseline resting electroencephalography (EEG) tracings with a high amplitude and low frequency oscillatory peaks of about 6-10 Hz over frontocentral regions. Methods: five consecutive patients with different neurocognitive disorders and baseline EEG dysrhythmias were treated open label with zopiclone, another selective GABA(A) receptor agonist. Results: In this case series, we describe remarkable improvement of cognition, motricity andproblematic behavior after zopiclone administration. Conclusions: These preliminary clinical findings and the significant body of research, implicating GABAergic mechanisms in the pathophysiology of an heterogeneous group of neurocognitive disorders, warrant further investigation of zopiclone and other selective GABA agonists.
NO. 2 A SYSTEMATIC REVIEW AND METAANALYSIS OF ACTIVE VERSUS SHAM DEEP BRAIN STIMULATION FOR OBSESSIVE-COMPULSIVE AND DEPRESSIVE DISORDERS Speaker: Steve Kisely, M.D., Ph.D. Co-Author(s): Katherine Hall, B.S, Dan Siskind M.B., M.P.H, Ph.D., Julanne Frater, M.B., Sarah Olsen M.B. B.S., David Crompton, M.B. EDUCATIONAL OBJECTIVE: At the conclusion of the session, the participant should be able to: 1) Understand methodological issues in the application of randomized controlled trials to the evaluation of deep brain stimulation; 2) Appreciate the current evidence-base for deep brain stimulation in the treatment of psychiatric disorders; and 3) Understand issues in obtaining informed consent for the procedure.
SUMMARY: Background: Deep brain stimulation (DBS) is increasingly being applied to psychiatric disorders such as obsessive-compulsive disorders, major depression and anorexia nervosa. Double-blind, randomized controlled
trials of active versus sham treatment have been limited to very small numbers the largest single study to date had only 16 subjects. We undertook a systematic review and metaanalysis on the effectiveness of DBS in psychiatric conditions. Method: A systematic literature search for double-blind, randomized controlled trials of active versus sham treatment for obsessive-compulsive and depressive disorders using PubMed/Medline and EMBASE up till April 2013. Where possible we combined results from studies in a meta-analysis. We assessed differences in final values between the active and sham treatments for parallel-group studies and compared the results of paired analyses in changes from baseline score for cross-over designs. Results: Five studies met inclusion criteria, all of which were of obsessivecompulsive disorder. 44 subjects provided data for the meta-analysis. The main outcome was a reduction in obsessive symptoms measured by the Yale Brown Obsessive Compulsive Scale. Patients on active, as opposed to sham, treatment had a significantly lower mean score (MD 8.93; 95% CI, -13.35 to 5.76; P
