PAULO JENG CHIAN SUEN
Projetos de Pesquisa
Unidades Organizacionais
LIM/27 - Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina
6 resultados
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- A study protocol for an ongoing multi-arm, randomized, double-blind, sham-controlled clinical trial with digital features, using portable transcranial electrical stimulation and internet-based behavioral therapy for major depression disorders: The PSYLECT study(2022) BORRIONE, Lucas; CIRILLO, Patricia C.; APARICIO, Luana V. M.; CAVENDISH, Beatriz A.; VALIENGO, Leandro; MOURA, Darin O.; SOUZA, Juliana P. de; LUETHI, Matthias S.; KLEIN, Izio; BARIANI, Bruna; GALLUCCI-NETO, Jose; SUEN, Paulo; PADBERG, Frank; GOERIGK, Stephan; VANDERHASSELT, Marie-Anne; DENG, Zhi De; O'SHEA, Jacinta; LOTUFO, Paulo A.; BENSENOR, Isabela M.; BRUNONI, Andre R.Background Transcranial electrical stimulation (tES) is considered effective and safe for depression, albeit modestly, and prone to logistical burdens when performed in external facilities. Investigation of portable tES (ptES), and potentiation of ptES with remote psychological interventions have shown positive, but preliminary, results. Research design We report the rationale and design of an ongoing multi-arm, randomized, double-blind, sham-controlled clinical trial with digital features, using ptES and internet-based behavioral therapy (iBT) for major depressive disorder (MDD) (NCT04889976). Methods We will evaluate the efficacy, safety, tolerability and usability of (1) active ptES + active iBT ('double-active'), (2) active ptES + sham iBT ('ptES-only'), and (3) sham ptES + sham iBT ('double-sham'), in adults with MDD, with a Hamilton Depression Rating Scale - 17 item version (HDRS-17) score >= 17 at baseline, during 6 weeks. Antidepressants are allowed in stable doses during the trial. Results We primarily co-hypothesize changes in HDRS-17 will be greater in (1) 'double-active' compared to 'ptES-only,' (2) 'double-active' compared to 'double-sham,' and (3) 'ptES-only' compared to 'double-sham.' We aim to enroll 210 patients (70 per arm). Conclusions Our results should offer new insights regarding the efficacy and scalability of combined ptES and iBT for MDD, in digital mental health.
- Prefrontal resting-state connectivity and antidepressant response: no associations in the ELECT-TDCS trial(2021) BULUBAS, Lucia; PADBERG, Frank; MEZGER, Eva; SUEN, Paulo; BUENO, Priscila V.; DURAN, Fabio; BUSATTO, Geraldo; JR, Edson Amaro; BENSENOR, Isabela M.; LOTUFO, Paulo A.; GOERIGK, Stephan; GATTAZ, Wagner; KEESER, Daniel; BRUNONI, Andre R.Functional and structural MRI of prefrontal cortex (PFC) may provide putative biomarkers for predicting the treatment response to transcranial direct current stimulation (tDCS) in depression. A recent MRI study from ELECT-TDCS (Escitalopram versus Electrical Direct-Current Theror Depression Study) showed that depression improvement after tDCS was associated with gray matter volumes of PFC subregions. Based thereon, we investigated whether antidepressant effects of tDCS are similarly associated with baseline resting-state functional connectivity (rsFC). A subgroup of 51 patients underwent baseline rsFC-MRI. All patients of ELECT-TDCS were randomized to three treatment arms for 10 weeks (anodal-left, cathodal-right PFC tDCS plus placebo medication; escitalopram 10 mg/day for 3 weeks and 20 mg/day thereafter plus sham tDCS; and placebo medication plus sham tDCS). RsFC was calculated for various PFC regions and analyzed in relation to the individual antidepressant response. There was no significant association between baseline PFC connectivity of essential structural regions, nor any other PFC regions (after correction for multiple comparisons) and patients' individual antidepressant response. This study did not reveal an association between antidepressants effects of tDCS and baseline rsFC, unlike the gray matter volume findings. Thus, the antidepressant effects of tDCS may be differentially related to structural and functional MRI measurements.
- White matter predicts tDCS antidepressant effects in a sham-controlled clinical trial study(2023) ZANAO, Tamires A.; LUETHI, Matthias S.; GOERIGK, Stephan; SUEN, Paulo; DIAZ, Alexandre P.; SOARES, Jair C.; BRUNONI, Andre R.Transcranial direct current stimulation (tDCS) has been used as treatment for depression, but its effects are heterogeneous. We investigated, in a subsample of the clinical trial Escitalopram versus Electrical Direct Current Therapy for Depression Study (ELECTTDCS), whether white matter areas associated with depression disorder were associated with tDCS response. Baseline diffusion tensor imaging data were analyzed from 49 patients (34 females, mean age 41.9) randomized to escitalopram 20 mg/day, tDCS (2 mA, 30 min, 22 sessions), or placebo. Antidepressant outcomes were assessed by Hamilton Depression Rating Scale-17 (HDRS) after 10-week treatment. We used whole-brain tractography for extracting white matter measures for anterior corpus callosum, and bilaterally for cingulum bundle, striato-frontal, inferior occipito-frontal fasciculus and uncinate. For the rostral body, tDCS group showed higher MD associated with antidepressant effects (estimate = -5.13 +/- 1.64, p = 0.002), and tDCS significantly differed from the placebo and the escitalopram group. The left striato-frontal tract showed higher FA associated with antidepressant effects (estimate = -2.14 +/- 0.72, p = 0.003), and tDCS differed only from the placebo group. For the right uncinate, the tDCS group lower AD values were associated with higher HDRS decrease (estimate = -1.45 +/- 0.67, p = 0.031). Abnormalities in white matter MDD-related areas are associated with tDCS antidepressant effects. Suggested better white matter microstructure of the left prefrontal cortex was associated with tDCS antidepressant effects. Future studies should investigate whether these findings are driven by electric field diffusion and density in these areas.
- Association between tDCS computational modeling and clinical outcomes in depression: data from the ELECT-TDCS trial(2021) SUEN, Paulo J. C.; DOLL, Sarah; BATISTUZZO, Marcelo C.; BUSATTO, Geraldo; RAZZA, Lais B.; PADBERG, Frank; MEZGER, Eva; BULUBAS, Lucia; KEESER, Daniel; DENG, Zhi-De; BRUNONI, Andre R.Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation intervention investigated for the treatment of depression. Clinical results have been heterogeneous, partly due to the variability of electric field (EF) strength in the brain owing to interindividual differences in head anatomy. Therefore, we investigated whether EF strength was correlated with behavioral changes in 16 depressed patients using simulated electric fields in real patient data from a controlled clinical trial. We hypothesized that EF strength in the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC), brain regions implicated in depression pathophysiology, would be associated with changes in depression, mood and anxiety scores. SimNIBS were used to simulate individual electric fields based on the MRI structural T1-weighted brain scans of depressed subjects. Linear regression models showed, at the end of the acute treatment phase, that simulated EF strength was inversely associated with negative affect in the bilateral ACC (left: beta = - 160.463, CI [- 291.541, - 29.385], p = 0.021; right: beta = - 189.194, CI [- 289.479, - 88.910], p = 0.001) and DLPFC (left: beta = - 93.210, CI [- 154.960, - 31.461], p = 0.006; right: beta = - 82.564, CI [- 142.867, - 22.262], p = 0.011) and with depression scores in the left ACC (beta = - 156.91, CI [- 298.51, - 15.30], p = 0.033). No association between positive affect or anxiety scores, and simulated EF strength in the investigated brain regions was found. To conclude, our findings show preliminary evidence that EF strength simulations might be associated with further behavioral changes in depressed patients, unveiling a potential mechanism of action for tDCS. Further studies should investigate whether individualization of EF strength in key brain regions impact clinical response.
- Digitalized transcranial electrical stimulation: A consensus statement(2022) BRUNONI, Andre R.; EKHTIARI, Hamed; ANTAL, Andrea; AUVICHAYAPAT, Paradee; BAEKEN, Chris; BENSENOR, Isabela M.; BIKSON, Marom; BOGGIO, Paulo; BORRONI, Barbara; BRIGHINA, Filippo; BRUNELIN, Jerome; CARVALHO, Sandra; CAUMO, Wolnei; CIECHANSKI, Patrick; CHARVET, Leigh; CLARK, Vincent P.; KADOSH, Roi Cohen; COTELLI, Maria; DATTA, Abhishek; DENG, Zhi-De; RAEDT, Rudi De; RIDDER, Dirk De; FITZGERALD, Paul B.; FLOEL, Agnes; FROHLICH, Flavio; GEORGE, Mark S.; GHOBADI-AZBARI, Peyman; GOERIGK, Stephan; HAMILTON, Roy H.; JABERZADEH, Shapour J.; HOY, Kate; KIDGELL, Dawson J.; ZONOOZI, Arash Khojasteh; KIRTON, Adam; LAUREYS, Steven; LAVIDOR, Michal; LEE, Kiwon; LEITE, Jorge; LISANBY, Sarah H.; LOO, Colleen; MARTIN, Donel M.; MINIUSSI, Carlo; MONDINO, Marine; MONTE-SILVA, Katia; MORALES-QUEZADA, Leon; NITSCHE, Michael A.; OKANO, Alexandre H.; OLIVEIRA, Claudia S.; ONARHEIM, Balder; PACHECO-BARRIOS, Kevin; PADBERG, Frank; NAKAMURA-PALACIOS, Ester M.; PALM, Ulrich; PAULUS, Walter; PLEWNIA, Christian; PRIORI, Alberto; RAJJI, Tarek K.; RAZZA, Lais B.; REHN, Erik M.; RUFFINI, Giulio; SCHELLHORN, Klaus; ZARE-BIDOKY, Mehran; SIMIS, Marcel; SKORUPINSKI, Pawel; SUEN, Paulo; THIBAUT, Aurore; VALIENGO, Leandro C. L.; VANDERHASSELT, Marie-Anne; VANNESTE, Sven; VENKATASUBRAMANIAN, Ganesan; VIOLANTE, Ines R.; WEXLER, Anna; WOODS, Adam J.; FREGNI, FelipeObjective: Although relatively costly and non-scalable, non-invasive neuromodulation interventions are treatment alternatives for neuropsychiatric disorders. The recent developments of highly-deployable transcranial electric stimulation (tES) systems, combined with mobile-Health technologies, could be incorporated in digital trials to overcome methodological barriers and increase equity of access. The study aims are to discuss the implementation of tES digital trials by performing a systematic scoping review and strategic process mapping, evaluate methodological aspects of tES digital trial designs, and provide Delphi-based recommendations for implementing digital trials using tES. Methods: We convened 61 highly-productive specialists and contacted 8 tES companies to assess 71 issues related to tES digitalization readiness, and processes, barriers, advantages, and opportunities for implementing tES digital trials. Delphi-based recommendations (>60% agreement) were provided. Results: The main strengths/opportunities of tES were: (i) non-pharmacological nature (92% of agreement), safety of these techniques (80%), affordability (88%), and potential scalability (78%). As for weaknesses/threats, we listed insufficient supervision (76%) and unclear regulatory status (69%). Many issues related to methodological biases did not reach consensus. Device appraisal showed moderate digitalization readiness, with high safety and potential for trial implementation, but low connectivity. Conclusions: Panelists recognized the potential of tES for scalability, generalizability, and leverage of digital trials processes; with no consensus about aspects regarding methodological biases. Significance: We further propose and discuss a conceptual framework for exploiting shared aspects between mobile-Health tES technologies with digital trials methodology to drive future efforts for digitizing tES trials.
- Classification of unipolar and bipolar depression using machine learning techniques(2021) SUEN, Paulo J. C.; GOERIGK, Stephan; RAZZA, Lais B.; PADBERG, Frank; PASSOS, Ives Cavalcante; BRUNONI, Andre R.