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Papers by Dirk Van Den Abbeele

Psychological Medicine, 2008

Background. Vagus nerve stimulation (VNS) therapy is associated with a decrease in seizure freque... more Background. Vagus nerve stimulation (VNS) therapy is associated with a decrease in seizure frequency in partial-onset seizure patients. Initial trials suggest that it may be an effective treatment, with few side-effects, for intractable depression.

Psychiatry Research: Neuroimaging, 2010

Journal of Psychosomatic Research, 1999

Twenty patients with Parkinson's disease (age range 38-70 years) complete... more Twenty patients with Parkinson's disease (age range 38-70 years) completed the Sickness Impact Profile (SIP) 2 months before and 3 months after long-term high-frequency electrostimulation of the globus pallidus internus to improve clinical symptoms. The SIP provides an estimate of perceived quality of life on 12 health-status categories. Neurological assessment with the Hoehn and Yahr scale and the Unified Parkinson's Disease Rating Scale revealed a significant postoperative reduction in clinical symptomatology (p<0.001). The patients experienced a general improvement in self-reported quality of life that exceeded the purely motor and physical aspects of quality of life. The significant postoperative drop in perceived impairment of communication skills can be considered the most important subjective improvement. Longitudinal research on a larger sample of patients is necessary to evaluate the durability of the subjective improvement in quality of life after unilateral pallidal stimulation.

Acta Neuropsychiatrica, 2013

Deep brain stimulation (DBS) has proven to be an effective treatment for patients with refractory... more Deep brain stimulation (DBS) has proven to be an effective treatment for patients with refractory symptoms in the advanced stages of Parkinson's disease. However, different psychiatric and cognitive problems may occur after DBS. We report a case of a manic episode after DBS of the subthalamic nucleus in a patient with advanced Parkinson's disease. After slow and gradually restart of the neurostimulation using the lowest effective intensity, the motor symptoms remained sufficiently under control without causing any psychiatric problems.

Tijdschrift voor Geneeskunde

Nuclear Medicine Communications, 2000

High-frequency stimulation of the internal pallidum is an effective surgical approach for patient... more High-frequency stimulation of the internal pallidum is an effective surgical approach for patients with advanced Parkinson's disease suffering from motor fluctuations and L-dopa induced dyskinesia. To study the acute effects of internal pallidum stimulation, changes in cerebral blood flow were measured by means of a single-day split-dose protocol using 99Tc(m)-ECD SPET. Nine patients with advanced Parkinson's disease and with a clinical picture predominated by tremor and drug-induced dyskinesia, were imaged before and immediately after electrostimulation. Brain perfusion data were mirrored to the same electrode side (five left and four right implants), co-registered and analysed statistically on a voxel-by-voxel basis (Statistical Parametric Mapping) and by an automated volume-of-interest approach. Acute stimulation of the internal pallidum induced a significantly decreased perfusion in the ipsilateral thalamus and striatum, as well as in the right parietal cortex. For the subgroup of seven patients with effective motor score improvements, a significant correlation between thalamic and striatal perfusion changes and UPDRS III motor score was present (P = 0.04). These results suggest that effective stimulation of the internal globus pallidus may produce symptom relief through decreased activity in pallido-thalamo-cortical circuits.

Tijdschrift voor Geneeskunde, 2005

The journal of ECT, Jan 23, 2015

Tijdschrift voor Geneeskunde

Therapeutic repetitive transcranial magnetic stimulation (rTMS) in depression is applied over the... more Therapeutic repetitive transcranial magnetic stimulation (rTMS) in depression is applied over the prefrontal cortex. This brain region is known to play an important role in the control of saccades. We wanted to investigate whether the fast rTMS procedure affected saccadic activity in depression. Reflexive saccades (RS) and voluntary saccades were studied in 11 patients before and after therapeutic rTMS for

Journal of Clinical Psychopharmacology, 2010

One of the major goals of antidepressant treatment is a sustained response and remission of depre... more One of the major goals of antidepressant treatment is a sustained response and remission of depressive symptoms. Some of the previous studies of vagus nerve stimulation (VNS) have suggested antidepressant effects. Our naturalistic study assessed the efficacy and the safety of VNS in 74 European patients with therapy-resistant major depressive disorder. Psychometric measures were obtained after 3, 12, and 24 months of VNS. Mixed-model repeated-measures analysis of variance revealed a significant reduction (P e 0.05) at all the 3 time points in the 28-item Hamilton Rating Scale for Depression (HRSD 28 ) score, the primary outcome measure. After 2 years, 53.1% (26/49) of the patients fulfilled the response criteria (Q50% reduction in the HRSD 28 scores from baseline) and 38.9% (19/49) fulfilled the remission criteria (HRSD 28 scores e 10). The proportion of patients who fulfilled the remission criteria remained constant as the duration of VNS treatment increased. Voice alteration, cough, and pain were the most frequently reported adverse effects. Two patients committed suicide during the study; no other deaths were reported. No statistically significant differences were seen in the number of concomitant antidepressant medications. The results of this 2-year open-label trial suggest a clinical response and a comparatively benign adverse effect profile among patients with treatment-resistant depression.

European Psychiatry, 2012

ABSTRACT Major depressive disorder is a prevalent mental disorder. Although several interventions... more ABSTRACT Major depressive disorder is a prevalent mental disorder. Although several interventions are effective, treatment response (TR) remains difficult to predict.Objectives This study aimed a) to investigate whether cognitive functioning improved after treatment with escitalopram, b) to evaluate if baseline cognitive functioning predicted TR and c) to detect the biological processes underlying TR.Methods Thirty-seven patients and 32 healthy controls were included. Patients were treated with escitalopram flexible dose regime. Patients were assessed before treatment, 2 and 8 weeks after the start of escitalopram. Cognitive functioning was investigated using the STROOP colour word test, the verbal fluency test, future thinking task and the emotional STROOP test. Depressive symptoms were assessed using the BDI-II. Metabolism PET (18F-FDG) was performed at baseline and week 8.ResultsAll patients significantly differed from controls on cognitive (p < 0.01) and depressive (p < 0.001) measures at baseline, which further improved after treatment. In contrast to responders, significant differences were found between controls and non- responders before treatment on all cognitive measures. These differences disappeared after treatment except for the future-thinking task. In association, non-responders compared to responders showed a lower metabolism in the bilateral prefrontal cortex (p < 0.001), which normalized after treatment. Subcortical decrease in the frontal-striatal thalamic tract after treatment further differentiated responders from non-responder (p < 0.001).Conclusion Escitalopram improved depressive symptoms and cognitive functioning in depression. Poor treatment response of escitalopram may be associated with pre-treatment worse cognitive functioning and lower activity in the prefrontal cortex.

Acta Neuropsychiatrica, 2013

Deep brain stimulation (DBS) has proven to be an effective treatment for patients with refractory... more Deep brain stimulation (DBS) has proven to be an effective treatment for patients with refractory symptoms in the advanced stages of Parkinson's disease. However, different psychiatric and cognitive problems may occur after DBS. We report a case of a manic episode after DBS of the subthalamic nucleus in a patient with advanced Parkinson's disease. After slow and gradually restart of the neurostimulation using the lowest effective intensity, the motor symptoms remained sufficiently under control without causing any psychiatric problems.

Psychiatry research, Jan 15, 2014

Although well-defined predictors of response are still unclear, clinicians refer a variety of dep... more Although well-defined predictors of response are still unclear, clinicians refer a variety of depressed patients for a repetitive Transcranial Magnetic Stimulation (rTMS) treatment. It has been suggested that personality features such as Harm Avoidance (HA) and self-directedness (SD) might provide some guidance for a classical antidepressant treatment outcome. However, to date no such research has been performed in rTMS treatment paradigms. In this open study, we wanted to examine whether these temperament and character scores in particular would predict clinical outcome in refractory unipolar depressed patients when a typical high-frequency (HF)-rTMS treatment protocol is applied. Thirty six unipolar right-handed antidepressant-free treatment resistant depressed (TRD) patients, all of the melancholic subtype, received 10 HF-rTMS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). All patients were classified as at least stage III TRD and were assessed with the Temp...

Psychological Medicine, 2008

Background. Vagus nerve stimulation (VNS) therapy is associated with a decrease in seizure freque... more Background. Vagus nerve stimulation (VNS) therapy is associated with a decrease in seizure frequency in partial-onset seizure patients. Initial trials suggest that it may be an effective treatment, with few side-effects, for intractable depression.

Psychiatry Research: Neuroimaging, 2010

Journal of Psychosomatic Research, 1999

Twenty patients with Parkinson's disease (age range 38-70 years) complete... more Twenty patients with Parkinson's disease (age range 38-70 years) completed the Sickness Impact Profile (SIP) 2 months before and 3 months after long-term high-frequency electrostimulation of the globus pallidus internus to improve clinical symptoms. The SIP provides an estimate of perceived quality of life on 12 health-status categories. Neurological assessment with the Hoehn and Yahr scale and the Unified Parkinson's Disease Rating Scale revealed a significant postoperative reduction in clinical symptomatology (p<0.001). The patients experienced a general improvement in self-reported quality of life that exceeded the purely motor and physical aspects of quality of life. The significant postoperative drop in perceived impairment of communication skills can be considered the most important subjective improvement. Longitudinal research on a larger sample of patients is necessary to evaluate the durability of the subjective improvement in quality of life after unilateral pallidal stimulation.

Acta Neuropsychiatrica, 2013

Deep brain stimulation (DBS) has proven to be an effective treatment for patients with refractory... more Deep brain stimulation (DBS) has proven to be an effective treatment for patients with refractory symptoms in the advanced stages of Parkinson's disease. However, different psychiatric and cognitive problems may occur after DBS. We report a case of a manic episode after DBS of the subthalamic nucleus in a patient with advanced Parkinson's disease. After slow and gradually restart of the neurostimulation using the lowest effective intensity, the motor symptoms remained sufficiently under control without causing any psychiatric problems.

Tijdschrift voor Geneeskunde

Nuclear Medicine Communications, 2000

High-frequency stimulation of the internal pallidum is an effective surgical approach for patient... more High-frequency stimulation of the internal pallidum is an effective surgical approach for patients with advanced Parkinson's disease suffering from motor fluctuations and L-dopa induced dyskinesia. To study the acute effects of internal pallidum stimulation, changes in cerebral blood flow were measured by means of a single-day split-dose protocol using 99Tc(m)-ECD SPET. Nine patients with advanced Parkinson's disease and with a clinical picture predominated by tremor and drug-induced dyskinesia, were imaged before and immediately after electrostimulation. Brain perfusion data were mirrored to the same electrode side (five left and four right implants), co-registered and analysed statistically on a voxel-by-voxel basis (Statistical Parametric Mapping) and by an automated volume-of-interest approach. Acute stimulation of the internal pallidum induced a significantly decreased perfusion in the ipsilateral thalamus and striatum, as well as in the right parietal cortex. For the subgroup of seven patients with effective motor score improvements, a significant correlation between thalamic and striatal perfusion changes and UPDRS III motor score was present (P = 0.04). These results suggest that effective stimulation of the internal globus pallidus may produce symptom relief through decreased activity in pallido-thalamo-cortical circuits.

Tijdschrift voor Geneeskunde, 2005

The journal of ECT, Jan 23, 2015

Tijdschrift voor Geneeskunde

Therapeutic repetitive transcranial magnetic stimulation (rTMS) in depression is applied over the... more Therapeutic repetitive transcranial magnetic stimulation (rTMS) in depression is applied over the prefrontal cortex. This brain region is known to play an important role in the control of saccades. We wanted to investigate whether the fast rTMS procedure affected saccadic activity in depression. Reflexive saccades (RS) and voluntary saccades were studied in 11 patients before and after therapeutic rTMS for

Journal of Clinical Psychopharmacology, 2010

One of the major goals of antidepressant treatment is a sustained response and remission of depre... more One of the major goals of antidepressant treatment is a sustained response and remission of depressive symptoms. Some of the previous studies of vagus nerve stimulation (VNS) have suggested antidepressant effects. Our naturalistic study assessed the efficacy and the safety of VNS in 74 European patients with therapy-resistant major depressive disorder. Psychometric measures were obtained after 3, 12, and 24 months of VNS. Mixed-model repeated-measures analysis of variance revealed a significant reduction (P e 0.05) at all the 3 time points in the 28-item Hamilton Rating Scale for Depression (HRSD 28 ) score, the primary outcome measure. After 2 years, 53.1% (26/49) of the patients fulfilled the response criteria (Q50% reduction in the HRSD 28 scores from baseline) and 38.9% (19/49) fulfilled the remission criteria (HRSD 28 scores e 10). The proportion of patients who fulfilled the remission criteria remained constant as the duration of VNS treatment increased. Voice alteration, cough, and pain were the most frequently reported adverse effects. Two patients committed suicide during the study; no other deaths were reported. No statistically significant differences were seen in the number of concomitant antidepressant medications. The results of this 2-year open-label trial suggest a clinical response and a comparatively benign adverse effect profile among patients with treatment-resistant depression.

European Psychiatry, 2012

ABSTRACT Major depressive disorder is a prevalent mental disorder. Although several interventions... more ABSTRACT Major depressive disorder is a prevalent mental disorder. Although several interventions are effective, treatment response (TR) remains difficult to predict.Objectives This study aimed a) to investigate whether cognitive functioning improved after treatment with escitalopram, b) to evaluate if baseline cognitive functioning predicted TR and c) to detect the biological processes underlying TR.Methods Thirty-seven patients and 32 healthy controls were included. Patients were treated with escitalopram flexible dose regime. Patients were assessed before treatment, 2 and 8 weeks after the start of escitalopram. Cognitive functioning was investigated using the STROOP colour word test, the verbal fluency test, future thinking task and the emotional STROOP test. Depressive symptoms were assessed using the BDI-II. Metabolism PET (18F-FDG) was performed at baseline and week 8.ResultsAll patients significantly differed from controls on cognitive (p < 0.01) and depressive (p < 0.001) measures at baseline, which further improved after treatment. In contrast to responders, significant differences were found between controls and non- responders before treatment on all cognitive measures. These differences disappeared after treatment except for the future-thinking task. In association, non-responders compared to responders showed a lower metabolism in the bilateral prefrontal cortex (p < 0.001), which normalized after treatment. Subcortical decrease in the frontal-striatal thalamic tract after treatment further differentiated responders from non-responder (p < 0.001).Conclusion Escitalopram improved depressive symptoms and cognitive functioning in depression. Poor treatment response of escitalopram may be associated with pre-treatment worse cognitive functioning and lower activity in the prefrontal cortex.

Acta Neuropsychiatrica, 2013

Deep brain stimulation (DBS) has proven to be an effective treatment for patients with refractory... more Deep brain stimulation (DBS) has proven to be an effective treatment for patients with refractory symptoms in the advanced stages of Parkinson's disease. However, different psychiatric and cognitive problems may occur after DBS. We report a case of a manic episode after DBS of the subthalamic nucleus in a patient with advanced Parkinson's disease. After slow and gradually restart of the neurostimulation using the lowest effective intensity, the motor symptoms remained sufficiently under control without causing any psychiatric problems.

Psychiatry research, Jan 15, 2014

Although well-defined predictors of response are still unclear, clinicians refer a variety of dep... more Although well-defined predictors of response are still unclear, clinicians refer a variety of depressed patients for a repetitive Transcranial Magnetic Stimulation (rTMS) treatment. It has been suggested that personality features such as Harm Avoidance (HA) and self-directedness (SD) might provide some guidance for a classical antidepressant treatment outcome. However, to date no such research has been performed in rTMS treatment paradigms. In this open study, we wanted to examine whether these temperament and character scores in particular would predict clinical outcome in refractory unipolar depressed patients when a typical high-frequency (HF)-rTMS treatment protocol is applied. Thirty six unipolar right-handed antidepressant-free treatment resistant depressed (TRD) patients, all of the melancholic subtype, received 10 HF-rTMS sessions applied to the left dorsolateral prefrontal cortex (DLPFC). All patients were classified as at least stage III TRD and were assessed with the Temp...