Neuromodulatory treatments for psychiatric disease: A comprehensive survey of the clinical trial landscape

Elias, G. J. B.; Boutet, A.; Parmar, R.; Wong, E. H. Y.; Germann, J.; Loh, A.; Paff, M.; Pancholi, A.; Gwun, D.; Chow, C. T.; Gouveia, F. Venetucci; Harmsen, I. E.; Beyn, M. E.; Santarnecchi, E.; Fasano, A.; Blumberger, D. M.; Kennedy, S. H.; Lozano, A. M.; Baht, V.

Abstract:

Numerous neuromodulatory therapies are currently under investigation or in clinical use for the treatment of psychiatric conditions. We sought to catalogue past and present human research studies on psychiatric neuromodulation and identify relevant trends in this field. ClinicalTrials.gov (https://www.clinicaltrials.gov/) and the International Clinical Trials Registry Platform (https://www.who.int/ictrp/en/) were queried in March 2020 for trials assessing the outcome of neuromodulation for psychiatric disorders. Relevant trials were categorized by variables such as neuromodulation modality, country, brain target, publication status, design, and funding source. From 72,086 initial search results, 1252 unique trials were identified. The number of trials registered annually has consistently increased. Half of all trials were active and a quarter have translated to publications. The largest proportion of trials involved depression (45%), schizophrenia (18%), and substance use disorders (14%). Trials spanned 37 countries; China, the second largest contributor (13%) after the United States (28%), has increased its output substantially in recent years. Over 75% of trials involved non-convulsive non-invasive modalities (e.g., transcranial magnetic stimulation), while convulsive (e.g., electroconvulsive therapy) and invasive modalities (e.g., deep brain stimulation) were less represented. 72% of trials featured approved or cleared interventions. Characteristic inter-modality differences were observed with respect to enrollment size, trial design/phase, and funding. Dorsolateral prefrontal cortex accounted for over half of focal neuromodulation trial targets. The proportion of trials examining biological correlates of neuromodulation has increased. These results provide a comprehensive overview of the state of psychiatric neuromodulation research, revealing the growing scope and internationalism of this field.

Patologie/Applicazioni:

• Dipendenze
• Depressione
• Schizofrenia
• ADHD

Anno:

2021

Tipo di pubblicazione:

Articolo

Parola chiave:

TMS; tDCS; ADHD; disturbi alimentari; disturbi bipolari; depressione; schizofrenia; stimolazione elettrica transcranica; stimolazione magnetica transcranica

Testata scientifica:

Scientific direct

Mese:

10

Nota:

Questa review fornisce una panoramica completa dello stato della ricerca sulla neuromodulazione psichiatrica identificando le tendenze rilevanti in questo campo per il trattamento di depressione, schizofrenia, disturbi da uso di sostanze, PTSD, OCD, disturbi bipolari e alimentari. Le ricerche dimostrano un'internazionalizzazione crescente includendo sei continenti e 37 paesi. Le tecniche di neuromodulazione più studiate sono risultate essere le forme non invasive come TMS e tES, che insieme rappresntano il 75% degli studi presi in esame, confermando una sempre crescente tendenza all'utilizzo di queste tecniche dovuta ai loro numerosi vantaggi. L'indagine rivela un campo in continua espansione, specialmente per TMS e tDCS, con implicazioni significative per il futuro trattamento delle malattie psichiatriche basato sulla neuromodulazione.

DOI:

10.1016/j.brs.2021.08.021