cyril höschl
DESCRIPTION
QEEG-based prediction of response to antidepressant modalities. Cyril Höschl. www.hoschl.cz. National Institute of Mental Health Prague Psychiatric Centre & Charles University, 3 rd Medical Faculty , Prague. M. N I H. NATIONAL INSTITUTE OF MENTAL HEALTH. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/1.jpg)
Cyril Höschl www.hoschl.cz
National Institute of Mental HealthPrague Psychiatric Centre
& Charles University, 3rd Medical Faculty, Prague
QEEG-based prediction of response to antidepressant
modalities
6th International Congress on Psychopharmacology, Antalya 17 April 2014
NI HM
NATIONAL INSTITUTE OF MENTAL HEALTH
![Page 2: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/2.jpg)
Treatment of Depression•Only one-third of patients being treated with SSRIs for depression achieve remission on the first drug tried (Verqouwen AC et al. 2007; Bondolfi G et al. 2006; Trivedi et al.2006 )
•25-30% of non-responders to first-line treatment can achieve remission by switching to- or adding of a second medication (Papakostas GI et al. 2008; Ruhé HG et al.2006)
•Clinical improvement generally requires 4-12 weeks
• Over 30% of patients prescribed antidepressants discontinue treatment before 30 days of therapy (
(Sheehan et al.2004)
All of this leads to prolonged suffering of depressed patients and to enormous expenses for society
All of this leads to prolonged suffering of depressed patients and to enormous expenses for society
Every day in depression represents huge individual and social burden.
Every day in depression represents huge individual and social burden.Any intervention
shortening period of disability saves a lot of suffering and expenses.
Any intervention shortening period of disability saves a lot of suffering and expenses.
![Page 3: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/3.jpg)
Predictor: QEEG Cordance
•Calculated from quantitative EEG power values; integrates absolute and relative power information
•Associated with regional cerebral perfusion
•Provides information interpretable in the context of PET and SPECT neuroimaging studies of depression
Leuchter et al, Neuroimage 1994; Cook et al, EEG Clin Neurophysiol 1998; Leuchter et al, Psychiatry Res 1999
![Page 4: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/4.jpg)
δ (0,5-4Hz)σ (4-8 Hz)α (8-12 Hz)β (12-30Hz)
![Page 5: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/5.jpg)
lesionhypoperfusion
↓absolute spectrum
relative spectrum
![Page 6: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/6.jpg)
1. Absolute power values ɑ are reattributed to each individual electrode by averaging power from all bipolar electrode pairs sharing that electrode.
(Fp2-F4)+(F8-F4)+(C4-F4)+(Fz-F4)F4 =
4
4. Cordance calculation:
2. Relative power values are calculated
3. calculation of normalized absolute (ANORM (s,f)) and normalized relative (RNORM (s,f)) power values (absolute and relative power values at each electrode site (s) and for each frequency band (f ) are divided by AMAXf and RMAXf respectively).
www.cordance.com
![Page 7: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/7.jpg)
![Page 8: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/8.jpg)
Design of our studyBaseline MADRS, BDI, CGI, EEG IOnset of treatment
Screening MADRS, BDI, CGI,
Wash-out 5-7 days
1st week treatment MADRS, BDI, CGI, EEG II
4 weeks treatment MADRS, BDI, CGI, EEG III
Notes: BDI-Beck self-rating scale for depression; CGI-clinical global impression; MADRS-Montgomery & Asberg depression rating scale; EEG-electroencephalography
Distribution of EEG electrodes:
N=17 (8M;9F)MADRS>25Stage I criteriafor resistant depression (Thase and Rush, 1997)
Response was defined as equal to or more than 50% reduction of MADRS scores and remission as MADRS scores less than 12 points after four weeks of treatment.
Response was defined as equal to or more than 50% reduction of MADRS scores and remission as MADRS scores less than 12 points after four weeks of treatment.
5 responded (4 achieved remission )
5 responded (4 achieved remission )
MedicationResponders:Venlafaxine 2Escitalopram 1Clomipramine 1Bupropion 1
Non-responders:Venlafaxine 5Escitalopram 2Mirtazapine 1Citalopram 1Bupropion 1Clomipramine 1Milnacipran 1
![Page 9: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/9.jpg)
Bareš M, Brunovský M, Kopeček M, Novák T, Stopková P, Kožený J, Höschl C. Journal of Psychiatric Research 2006
Results
Positive predictive value (PPV) was 0.71 Negative predictive value (NPV) was 1.0
All responders showed decrease
10/12 non-responders showed increase
![Page 10: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/10.jpg)
Results
Condition
Positive Negative
Test outcome
Positive True positiveFalse positive(Type I error;
p- value)
→ Positive predictive value
Negative False Negative(Type II error)
True Negative→ Negative
predictive value
↓sensitivity
↓specificityHamlet
Othello
![Page 11: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/11.jpg)
Results
Depression
Response Non-response
Cordance
Positivedecrease
5 2 → PPV=0.71
Negativeincrease
0 10 → NPV=1.00
Sensitivity100%
Specificity>83%
![Page 12: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/12.jpg)
N=26 (8M;18F)MADRS>20Stage I criteriafor resistant depression (Thase and Rush, 1997)
Response was defined as equal to or more than 50% reduction of MADRS scores after four weeks of treatment.
![Page 13: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/13.jpg)
![Page 14: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/14.jpg)
Results
Depression
Response Non-response
Cordance
Positivedecrease
11 5 → PPV=0.69
Negativeincrease
1 8 → NPV=0.89
Sensitivity92%
Specificity>62%
![Page 15: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/15.jpg)
Predictor: QEEG Cordance
•QEEG cordance integrates absolute and relative power information.
•Change of QEEG average cordance from 3 frontal electrodes (Fp1, Fp2 and Fz) in theta band (4-8Hz) predicts therapeutic response to antidepressants after one week of AD administration
•PPV≈0.7; NPV≈0.9; SENS 90-100%; SPEC 60-90%
Any intervention shortening period of disability saves a lot of suffering and expenses.
Any intervention shortening period of disability saves a lot of suffering and expenses.
Conclusions
![Page 16: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/16.jpg)
0
+
-
Predictor: QEEG Cordance
•QEEG cordance might reflect activity changes in CG25
Conclusions
![Page 17: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/17.jpg)
0
+
-
Predictor: QEEG Cordance
•QEEG cordance might reflect activity changes in CG25
Conclusions
![Page 18: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/18.jpg)
Comparison between AUCs obtained for MADRS reduction and cordance change at week 1
in the prediction of treatment response
0 10 20 30 40 50 60 70 80 90 100
0
10
20
30
40
50
60
70
80
90
100
100-Specificity
Sen
sitiv
ity
%w1 MADRSCO2-CO1
AUC=0.82
AUC = 0.65
Pairwise comparison of ROC curves, z-statistic=2.55, p=0.01
Bareš et al. 2011
![Page 19: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/19.jpg)
Comparison of predictive power of cordance change in rTMS and VNF Tx
• AUC rTMS=0,75 (N=25)• AUC VNF=0,89 (N=25)
p=0,27MADRS0 26(24-30) 25(24-30) NSMADRS28 18(12-25) 18(10-24) NS
rTMS VNF
Bareš et al., Clin EEG Neurosci (in press)
NS
![Page 20: Cyril Höschl](https://reader035.vdocuments.mx/reader035/viewer/2022062221/56813e53550346895da841fe/html5/thumbnails/20.jpg)
Martin Brunovský
Psychiatric Centre Prague & Charles University, 3rd Medical Faculty, Prague
Milan KopečekMartin Bareš
Jiří Kožený
Pavla Stopková
Tomáš Novák
Thanks to the team of
Peter ŠóšVladimír Krajča