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Traditional Medicine-2015 Birmingham, UK August 03 – 05, 2015

Traditional Medicine-2015 Birmingham, UK August 03 – 05, 2015. Traditional Medicine 2015. PeiJing Rong. Clinical Trial of Transcutaneous Vagus Nerve Stimulation in Major Depressive Disorder and its Neuromechanism using fMRI Peijing Rong Prof. PhD

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Traditional Medicine-2015 Birmingham, UK August 03 – 05, 2015

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  1. Traditional Medicine-2015Birmingham, UKAugust 03 – 05, 2015 Traditional Medicine 2015 PeiJing Rong

  2. Clinical Trial of Transcutaneous Vagus Nerve Stimulation in Major Depressive Disorder and its Neuromechanism using fMRI Peijing Rong Prof. PhD Jiliang Fang MD. PhD China Academy of Chinese Medical Sciences August 3th, 2015 Birmingham, UK

  3. Background FDA approved the Vagus stimulation as a alternative treatment for drug-resistance depression in 2005.

  4. Auricular acupuncture－Vagus nerve • Basis of Anatomy： Concha － － Only Distribution of vagus nerve on body surface Distribution of vagus N. Area of Inner organs

  5. Transcutaneous VNS The stimulator invented by Acupuncture Institute it treats MDD and epilepsy effectively Rong PJ,et al. World Science and Technology/Modernization of Traditional Chinese Medicine and Materia Medica. 2014. Vol.15 No.9: 2013-2020

  6. Clinical trial for tVNSon Depression tVNS on 37 MDD for 2 weeks. On days 0 and 14, showed a significantly better outcome in the BDI. HAMD score did not change significantly in the two groups. Review: Larger sample size and longer duration of treatment are needed. Hein E, et al(2013).J Neural Transmission

  7. Our Clinical Trial

  8. Clinical controlled trial • Duration：Sept.2012 – March. 2014 • Three centers：GAM Hopital CACMS FGS Hospital BUCM Acu Hospital CACMS • MDD: 160 cases mild-moderate symptom tVNS（91） stVNS（69）

  9. Methods • Parameter: 20Hz，4-6mA，30min per time，twice daily, 5 days in a week • 12weeks for tVNS, 4 weeks for stVNS, then transfer to tVNS

  10. Measurements • Mental psychological scales： • 24HAMD • 17HAMA • SAS • SDS

  11. Curative effect standard • Reduction of 24-HAMD score • recovery≥75％ • Significant  effective 50％～74％ • effective 25％～49％ • no effective <25％

  12. Percentage of Efficiency

  13. Change of clinical Measurements

  14. Change of clinical Measurements

  15. Clinical Trial of Transcutaneous Vagus Nerve Stimulation On Major Depression Disorder Rong PG, Fang JL, et al. J Clinical Psychiatry under reviewing

  16. Brain Imaging on the Neuromechanism

  17. tVNS Modulates Default Mode Network on MDD Fang Jiliang et al. 2015.5 Epub online Biological Psychiatry

  18. Biological Psychiatry（IF 10.225）

  19. Default Mode Network (DMN) • DMN is a network of brain regions that are active when an individual is awake and at rest. • It is an interconnected and anatomically defined brain system that preferentially activates when individuals focus on internal tasks such as daydreaming, envisioning the future, retrieving memories, and gauging others' perspectives.[2 • 0] • It is one of the most studied networks present during resting state and is one of the most easily visualized networks.[21]

  20. Default Mode Network (DMN) Fox. (2005) PNAS

  21. Our fMRI study on tVNS • Using fMRI to monitor the changes of brain function Connectivity in the DMN after tVNS or sham tVNS treatment on MDD. • To find the correlation between brain response (FC) with the clinical symptom (24 HAMD). Jiliang Fang et al., 2014. 6 JMRI Fang Jiliang et al. 2015.5 Biological Psychiatry Jiliang Fang et al.，2015 Brain Stimulation Submitted

  22. Studies on DMN of MDD Zhu X et al., 2012 Anand A et al., Biol Psychiatry, 2005; Anand A et al.,Neuropsychopharmacology, 2005;Greicius MD et al., Biol Psychiatry 2007;Bluhm R et al., Psychiatry Clin Neurosci, 2009; Zhu X et al., Biol Psychiatry, 2012;Veer IM et al., Front Syst Neurosci, 2010. 

  23. Abnormal FC in DMN of MDD Depression is characterized by both stimulus-induced heightened activity and a failure to normally down-regulate activity broadly within the DMN Sheline YI, Raichle, ME.  PNAS 2009

  24. Antidepressant modulated brain Network antidepressant treatment may increase corticolimbic connectivity, thereby possibly increasing the regulatory influence of cortical mood-regulating regions over limbic regions. Chen et al. (2015), Journal of Affective disorder; Anand et al. 2005, Neuropsychopharmacology

  25. fMRI Method tVNS group（19），Control group（16） 1.5T GE MRI, 6 min resting state EPIscan, repeat once. TR2.5s，TE30ms，Thickness 3mm，gap 0.5mm，Parallel AC-PC line 41Slices Before and after 4 weeks treatment

  26. fMRIdata processing using independent component analysis (ICA) in the FMRIB, acquired the component of the default mode network. The FC changes after treatment (posttreatment - pretreatment) in the tVNS group with that of the stVNS group. The correlation areas of FC changes and clinical measurement.

  27. Baseline：tVNS VS. stVNS

  28. Clinical measurement Changes

  29. Component of Default Mode Network

  30. tVNS VS. stVNS FC changes after treatment

  31. stVNS VS. tVNS FC changes after treatment

  32. tVNS VS. stVNS Important decreased FC Areas

  33. Brain Regions of FC Changes positively associated with HAMD

  34. Important Regions in Positive Correlation

  35. Brain Regions of FC Changes Negativelyassociated with HAMD

  36. Yellow: Important areas with FC increase Blue: Areas with FC negatively related to HAMD

  37. Conclusion（1） 1） tVNSis effective for MDD 2）tVNS provides an easy, simple and cheap non-medication treatment for MDD.

  38. Conclusion（2） 1）Evidence for Hypothesis：tVNS modulating Default Mode network(DMN). 2）tVNS produces Functional Connectivity changes： Insular, dACC—Salient network, keep balance between Executive control network and DMN Orbital FC，Precuneus—Emotion, Cognition

  39. The network of Vagus Nerve project to Default Mode Network

  40. tVNS on the Neural Circuitry of Mood NTS：孤束核 LC：蓝斑核 VTA：腹侧被盖区 Hyp：下丘脑 Amy：杏仁核 HP： 海马 NAC：伏核 OFC：眶回 MPFC：内侧前额叶 ACC：前扣带回 MCC：中扣带回 PCC：后扣带回

  41. Acknowledgement Prof. Peijing Rong, Bing Zhu, Xiaochun Yu Institute of acupuncture, CACMS Assitant Prof. Jian Kong, Martinos Center, Dept. of Psychiatry,MGH, Harvard University Hong Yang, Yangyang Fan, Jun Liu, Honghong Wang, Guang An Men Hospital, CACMS

  42. Grant Key Program for Beijing Natural Science Foundation ( 71110070 ) National Natural Science Foundation of China (30870668，81273674，81303056) Funding from Ministry of Science and Technology (2012BAF14B10)

  43. Society of Medical Imaging China Association of Acupuncture & Moxibustion 2014 Beijing

  44. Welcome to join the team for acupuncture research using fMRIJiliang Fang fangmgh@163.comhttp://zjyx.dic120.com/ Beijing, China

  45. Meet the eminent gathering once again atTraditional Medicine-2016London, UKOctober 03-05, 2016 Traditional Medicine-2016 Website: http://traditionalmedicine.conferenceseries.com/

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