@martijn-arns
Brainclinics Foundation & Stanford University | Neuroscientist | Entrepreneur | TMS | Psychedelics | Neurofeedback/BCI | Depression | Heart-Brain Coupling | Stratified Psychiatry | ADHD | Sleep | Chronobiology | Marathon running | Guitar |
Looking forward presenting tomorrow, will bridge the gap between biofeedback and TMS-induced Heart-Brain Coupling.
Online meeting, so accesible from anywhere...
See you there!
aapb.starchapter.com/meetinginfo....
Even taking more specific TRD treatments e.g. SAINT (50% remission); our own TMS+psychotherapy data (56% remission), a 76% remission rate is high.
SAINT Replication: onlinelibrary.wiley.com/doi/10.1002/...
TMS+Psychotherapy: www.brainstimjrnl.com/article/S193...
To put this into perspective, here all reponse/remission rates for current treatments in MDD and TRD from largest open-label trials incl. STAR*D, iSPOT-D, Blumberger et al. etc. Normally 30-40% remission rate in TRD.
See here for refs: www.nature.com/articles/s44...
But why use 8mg+8mg in prospective Ph3 study (instead of 8+12mg)? Use of 4mg as a control also sounds risky, might lack 'dose-response' effects.
Impressive results by AtaiBeckley re BPL-003: 76% remission after just 2 doses (8mg+12mg) after 2 mo. in Ph2B. Higher than other interventional psychiatry tx such as accelerated TMS, requiring less time.
Clinical practice is ahead of the evidence. This paper tries to bring structure.
Curious how others approach maintenance in their clinics.
Congrats Iris Dalhuisen for leading this effort!
Highlights:
• Tapering may help early stability
• Clustered protocols (5 sessions/month) show the most consistent signal
• Retreatment is highly effective in prior responders
• Controlled trials are still largely missing
What do we do after a patient responds to rTMS?
Taper? Monthly maintenance? Wait for relapse and retreat?
Just published a consensus statement (NL+Belgium) reviewing 22 studies on maintenance rTMS and combining this with clinical survey data and patient input.
www.sciencedirect.com/science/arti...
Congrats Lena Kozyr and team with this publication!
Complexity or simplicity? A replication analysis of low heart rate as a predictor of TMS response in major depressive disorder: www.sciencedirect.com/science/arti...
Low heart-rate as a predictor for TMS response: Sometimes the simpler metric is better than the more complex metrics: No effects of complexity/non-linear HRV measures, but low heart-rate robustly predicts better response to TMS (HF and LF TMS), replicated in SAINT iTBS sample.
Fostering robustness and reproducibility in applied neuroscience and AI/ML:
We have a new TDBRAIN Lead for prediction of MDD status using EEG with AI/ML with a balanced accuracy of 63%, congrats Neumarker Inc, Qiang Li & Ken Wang!
Who will improve this further?
brainclinics.com/research/art...
Replication of SAINT-aiTBS in depression in new double-blind study demonstrating even higher remission of 50% at 4-wks FU!
onlinelibrary.wiley.com/doi/10.1002/...
Alternative could be the APA guidelines for rating evidence based medicine, however those are quite dated in my view, also see for discussion and updated proposal here: link.springer.com/article/10.1...
Considered the evidence based guidelinesof the Brain Stimulation Guidelines by Lefaucheur et al?
pubmed.ncbi.nlm.nih.gov/25034472/
Big thanks also to Alexander Sack for donating a TMS machine and Trevor Brown, Klaus Schellhorn, DEYMED Diagnostic and others for support.
The initiative was made possible in collaboration with Dr Asad, Daniel Kropf and Education for Life.
Just came back from Palestine and really enjoyed training the UEF teams from Betlehem and Nablus on the use of TMS in mental health. We also donated two TMS systems for use in Bethlehem and Nablus, which makes it the first TMS available in Palestine!
And found similar spring based effect for low dose methylphenidate in ADHD (with better response in spring), also specific to inattention and omission errors, see:
link.springer.com/article/10.1...
We had some earlier results that were specific to a genotype, replicated across various datasets, related to the 'rate of change' in sunlight in spring. Was only published as a preprint, seeL www.biorxiv.org/content/10.1...
Did you also find a spring specific effect by any chance for any measure, eg maybe sustained attention?
Whether it's clinically better than racemic MDMA I couldn't say but here is a good piece from Gill Bedi looking at what we know...
Stanford University obituary for Nolan Williams.
You're missed Nolan...
med.stanford.edu/news/all-new...
For full access to the TDRAIN database also see: brainclinics.com/resources/td...
Many AI and ML studies suggest 'unrealistic' 90+% accuracies, all without proper out-of-sample replications. This was our main driver to release the open-access TDBRAIN database incl more then 1200 EEGs and rich phenotype data. Glad to see a first diagnostic replication with a realistic accuracy.
Congrats Kirby Wraith from The Australian National University with the #1 position at the TDBRAIN Challenge for replicated diagnostic predicton accuracy for Depression using EEG data only at a 62% balanced accuracy!
For full details see here: brainclinics.com/research/art...
Download the TDBRAIN dataset here: brainclinics.com/resources/td...
See full published data descriptor here: www.nature.com/articles/s41...
Some time ago we released the open-access TDBRAIN dataset with more than 1200 EEG's and rich phenotype data (ADHD, MDD and OCD), and include 'blinded' cases for out-of-sample validation. The results show it is not easy to get a succesful out-of-sample replication, but glad to see some groups do!
A new successful replication in the TDBRAIN challenge by Wei Wu and Yonghao Song in predicting TMS Response from EEG!
Let's focus on a future of robustness that can truly benefit patients!
brainclinics.com/research/art...
