. . "Stimula\u010Dn\u00ED metody v terapii deprese: vyu\u017Eit\u00ED vagov\u00E9 stimulace (VNS) a hlubok\u00E9 mozkov\u00E9 stimulace (DBS)" . . "Stimulatory methods in treatment of depression: the use of nerve vagus stimulation (VNS) and deep brain stimulation (DBS)"@en . . . . "4"^^ . . . "Stimula\u010Dn\u00ED metody v terapii deprese: vyu\u017Eit\u00ED vagov\u00E9 stimulace (VNS) a hlubok\u00E9 mozkov\u00E9 stimulace (DBS)"@cs . "RIV/00023752:_____/11:00001132!RIV12-MZ0-00023752" . . "Velk\u00FD po\u010Det depresivn\u00EDch pacient\u016F rezistentn\u00EDch na l\u00E9\u010Dbu p\u0159edstavuje klinick\u00FD probl\u00E9m. Vedle farmakoterapie byly do l\u00E9\u010Dby rezistentn\u00ED deprese ned\u00E1vno zavedeny dv\u011B nov\u00E9 reverzibiln\u00ED invazivn\u00ED stimula\u010Dn\u00ED metody, vagov\u00E1 stimulace (VNS) a hlubok\u00E1 mozkov\u00E1 stimulace (DBS). V p\u0159ehledu p\u0159in\u00E1\u0161\u00EDme souhrn mechanismu p\u016Fsoben\u00ED, neurobiologie a dostupn\u00FDch klinick\u00FDch dat o VNS a DBS u rezistentn\u00ED deprese. Podstatou VNS je stimulace lev\u00E9ho ram\u00E9nka nervus vagus v kr\u010Dn\u00ED oblasti pomoc\u00ED programovateln\u00E9ho stimul\u00E1toru. \u00DA\u010Dinnost VNS byla testov\u00E1na ve \u010Dty\u0159ech klinick\u00FDch studi\u00EDch s celkem 355 pacienty. VNS prok\u00E1zala postupn\u011B nar\u016Fstaj\u00EDc\u00ED zlep\u0161en\u00ED s pln\u00FDm \u00FA\u010Dinkem po 6-12 m\u011Bs\u00EDc\u00EDch stimulace a kter\u00FD byl udr\u017Een a\u017E po n\u00E1sleduj\u00EDc\u00ED 2 roky. Pacienti, kte\u0159\u00ED se zlep\u0161ili nejv\u00EDce, byli m\u00E1lo a\u017E st\u0159edn\u011B rezistentn\u00ED. Nicm\u00E9n\u011B prim\u00E1rn\u00ED v\u00FDsledky jedin\u00E9 kontrolovan\u00E9 studie byly negativn\u00ED. Princip DBS spo\u010D\u00EDv\u00E1 ve sterotaktick\u00E9 implantaci elektrod nap\u00E1jen\u00FDch pulzn\u00EDm gener\u00E1torem do specifick\u00FDch oblast\u00ED mozku. C\u00EDlov\u00FDmi oblastmi pro depresi je subthalamick\u00E9 j\u00E1dro, vnit\u0159n\u00ED globus pallidus, ventr\u00E1ln\u00ED capsula interna / ventr\u00E1ln\u00ED striatum, oblast subgenu\u00E1ln\u00ED cinguly a nucleus accumbens. Antidepresivn\u00ED \u00FA\u010Dinek DBS byl zkoum\u00E1n v kazuistick\u00FDch s\u00E9ri\u00EDch s celkov\u00FDm po\u010Dtem 50 pacient\u016F s rezistentn\u00ED depres\u00ED. Stimulace r\u016Fzn\u00FDch oblast\u00ED mozku vedla k rychl\u00E9 redukci p\u0159\u00EDznak\u016F deprese. Klinick\u00E1 data z aplikace VNS a DBS jsou povzbudiv\u00E1. Hlavn\u00EDm p\u0159\u00EDnosem obou metod je inovativn\u00ED p\u0159\u00EDstup, kter\u00FD umo\u017E\u0148uje p\u0159esn\u00E9 zac\u00EDlen\u00ED specifick\u00FDch oblast\u00ED mozku, jader a okruh\u016F \u00FA\u010Dastn\u00EDc\u00EDch se v patofyziologii neuropsychiatrick\u00FDch poruch. Je v\u0161ak zapot\u0159eb\u00ED v\u00EDce dat z kontrolovan\u00FDch studi\u00ED a je tak\u00E9 nutn\u00E9 vylou\u010Dit potenci\u00E1ln\u00ED placebo efekt. Relativn\u011B vysok\u00E1 incidence suicid\u00E1ln\u00EDho jedn\u00E1n\u00ED u DBS vede ke zv\u00FD\u0161en\u00E9 opatrnosti. Pro zaveden\u00ED do klinick\u00E9 praxe bude nutn\u00E9 identifikovat pacienty, kte\u0159\u00ED mohou z VNS a DBS profitovat." . . "Slav\u00ED\u010Dkov\u00E1, Anna" . "Mohr, Pavel" . . . . . . "Velk\u00FD po\u010Det depresivn\u00EDch pacient\u016F rezistentn\u00EDch na l\u00E9\u010Dbu p\u0159edstavuje klinick\u00FD probl\u00E9m. Vedle farmakoterapie byly do l\u00E9\u010Dby rezistentn\u00ED deprese ned\u00E1vno zavedeny dv\u011B nov\u00E9 reverzibiln\u00ED invazivn\u00ED stimula\u010Dn\u00ED metody, vagov\u00E1 stimulace (VNS) a hlubok\u00E1 mozkov\u00E1 stimulace (DBS). V p\u0159ehledu p\u0159in\u00E1\u0161\u00EDme souhrn mechanismu p\u016Fsoben\u00ED, neurobiologie a dostupn\u00FDch klinick\u00FDch dat o VNS a DBS u rezistentn\u00ED deprese. Podstatou VNS je stimulace lev\u00E9ho ram\u00E9nka nervus vagus v kr\u010Dn\u00ED oblasti pomoc\u00ED programovateln\u00E9ho stimul\u00E1toru. \u00DA\u010Dinnost VNS byla testov\u00E1na ve \u010Dty\u0159ech klinick\u00FDch studi\u00EDch s celkem 355 pacienty. VNS prok\u00E1zala postupn\u011B nar\u016Fstaj\u00EDc\u00ED zlep\u0161en\u00ED s pln\u00FDm \u00FA\u010Dinkem po 6-12 m\u011Bs\u00EDc\u00EDch stimulace a kter\u00FD byl udr\u017Een a\u017E po n\u00E1sleduj\u00EDc\u00ED 2 roky. Pacienti, kte\u0159\u00ED se zlep\u0161ili nejv\u00EDce, byli m\u00E1lo a\u017E st\u0159edn\u011B rezistentn\u00ED. Nicm\u00E9n\u011B prim\u00E1rn\u00ED v\u00FDsledky jedin\u00E9 kontrolovan\u00E9 studie byly negativn\u00ED. Princip DBS spo\u010D\u00EDv\u00E1 ve sterotaktick\u00E9 implantaci elektrod nap\u00E1jen\u00FDch pulzn\u00EDm gener\u00E1torem do specifick\u00FDch oblast\u00ED mozku. C\u00EDlov\u00FDmi oblastmi pro depresi je subthalamick\u00E9 j\u00E1dro, vnit\u0159n\u00ED globus pallidus, ventr\u00E1ln\u00ED capsula interna / ventr\u00E1ln\u00ED striatum, oblast subgenu\u00E1ln\u00ED cinguly a nucleus accumbens. Antidepresivn\u00ED \u00FA\u010Dinek DBS byl zkoum\u00E1n v kazuistick\u00FDch s\u00E9ri\u00EDch s celkov\u00FDm po\u010Dtem 50 pacient\u016F s rezistentn\u00ED depres\u00ED. Stimulace r\u016Fzn\u00FDch oblast\u00ED mozku vedla k rychl\u00E9 redukci p\u0159\u00EDznak\u016F deprese. Klinick\u00E1 data z aplikace VNS a DBS jsou povzbudiv\u00E1. Hlavn\u00EDm p\u0159\u00EDnosem obou metod je inovativn\u00ED p\u0159\u00EDstup, kter\u00FD umo\u017E\u0148uje p\u0159esn\u00E9 zac\u00EDlen\u00ED specifick\u00FDch oblast\u00ED mozku, jader a okruh\u016F \u00FA\u010Dastn\u00EDc\u00EDch se v patofyziologii neuropsychiatrick\u00FDch poruch. Je v\u0161ak zapot\u0159eb\u00ED v\u00EDce dat z kontrolovan\u00FDch studi\u00ED a je tak\u00E9 nutn\u00E9 vylou\u010Dit potenci\u00E1ln\u00ED placebo efekt. Relativn\u011B vysok\u00E1 incidence suicid\u00E1ln\u00EDho jedn\u00E1n\u00ED u DBS vede ke zv\u00FD\u0161en\u00E9 opatrnosti. Pro zaveden\u00ED do klinick\u00E9 praxe bude nutn\u00E9 identifikovat pacienty, kte\u0159\u00ED mohou z VNS a DBS profitovat."@cs . "Stimula\u010Dn\u00ED metody v terapii deprese: vyu\u017Eit\u00ED vagov\u00E9 stimulace (VNS) a hlubok\u00E9 mozkov\u00E9 stimulace (DBS)" . "Psychiatrie" . "CZ - \u010Cesk\u00E1 republika" . "10"^^ . . "P(1M0517), P(GD309/09/H072), S, Z(MZ0PCP2005)" . . "Hanka, Jan" . "Stimulatory methods in treatment of depression: the use of nerve vagus stimulation (VNS) and deep brain stimulation (DBS)"@en . "High number of treatment-resistant patients with depression poses a clinical problem. In addition to pharmacotherapy, reversible invasive stimulation methods, vagus nerve stimulation (VNS) and deep brain stimulation (DBS), have been introduced into the management of treatment-resistant depression (TRD). The paper reviews principles, neurobiology, and available clinical evidence of VNS and DBS in TRD. The basis of VNS is a stimulation of the left cervical vagus nerve with a programmable neurostimulator. Efficacy of VNS was examined in four clinical trials with 355 patients. VNS demonstrated steadily increasing improvement with full benefit after 6-12 months, sustained up to 2 years. Patients who responded best had a low-to-moderate antidepressant resistance. However, the primary results of the only controlled trial were negative. DBS involves stereotactical implantation of electrodes powered by a pulse generator into the specific brain regions. For depression, targeted areas are subthalamic nucleus, internal globus pallidus, ventral internal capsule/ventral striatum, the subgenual cingulated region, and nucleus accumbens. Antidepressant effects of DBS were examined in case series with the total number of 50 TRD patients. Stimulation of different brain regions resulted in rapid reduction of depressive symptoms. The clinical data on the use of VNS and DBS in TRD are encouraging. The major contribution of the methods is a novel approach that allows for precise targeting of the specific brain areas, nuclei and circuits implicated in etiopathogenesis of neuropsychiatric disorders. However, more controlled data are needed and potential impact of placebo effect has to be ruled out. Relatively high incidence of suicidal behavioral in DBS warrants caution. For clinical practice, patients who may benefit from VNS or DBS best should be identified."@en . "Rodriguez, Mabel" . . . "15" . "1211-7579" . "[FB34F0F93D22]" . . "RIV/00023752:_____/11:00001132" . "http://www.tigis.cz/images/stories/psychiatrie/2011/03/03_mohr_psych_3-11.pdf" . "treatment-resistant depression; vagus nerve stimulation; deep brain stimulation"@en . . . "Stimula\u010Dn\u00ED metody v terapii deprese: vyu\u017Eit\u00ED vagov\u00E9 stimulace (VNS) a hlubok\u00E9 mozkov\u00E9 stimulace (DBS)"@cs . "232397" . . "4"^^ . "3" .