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In the general population, as well as the elderly, the therapeutic benefits of antidepressant pharmacological treatments are less extensive and persistent than previously thought. Further, it is possible that, when providing symptomatic relief, some forms of antidepressant medication prevent the underlying illness episode from resolving, resulting in a high propensity for relapse recurrence and the need for lifetime treatment. In part, for this reason, and especially among the elderly, we have moved from conceptualizing major depression as a spontaneously remitting illness with return to good premorbid function to a chronic diabetes model, in which remission is rarely achieved and the need for long-term care nearly universal. The focal brain stimulation techniques comprise a new class of therapeutics with therapeutic properties distinct from that of pharmacological agents. All forms of focal brain sitmualtion fundamentally involve inducing the flow of electricity in neural tissue. As is especially evident with ECT, side effects are generally a function of the extent to which this stimulation is compatible with endogenous signaling principles. Since electricity has no metabolites, any lasting therapeutic or adverse effect is due to endogenous neural response to stimulation. Currently, 10 different forms of focal brain stimulation are undergoing development and clinical trials, with treatmentresistant depression TRD ; the most common indication. Each of these new technologies will be briefly described, with a special focus on applications in the elderly. Recent advances in electroconvulsive therapy, especially the use of ultrabrief stimulation and the development of focal electrically-administered seizure therapy FEAST ; will be highlighted. Similarly, other areas of special attention will include the current state of development of repetitive Transcranial Magnetic Stimulation rTMS ; , vagus nerve stimulation VNS ; , responsive brain stimulation NeuroPace ; , and deep brain stimulation DBS and calan.
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Choi BM, Kwak HJ, Jun CD, Park SD, Kim KY, Kim HR, Chung HT. Immunol Cell Biol. 1996 Apr; 74 2 ; : 144-50. Control of scarring in adult wounds using antisense transforming growth factor-beta 1 oligodeoxynucleotides. 787 tracheostomy surgery mitomycin 788 Martini E, Laffi GL, Sprovieri C, Scorolli L. Eur J Ophthalmol. 1997 Jan-Mar; 7 1 ; : 40-8. Low-dosage mitomycin C as an adjunct to trabeculectomy. A prospective controlled study. 789 Bindlish R, Condon GP, Schlosser JD, D'Antonio J, Lauer KB, Lehrer R. Ophthalmology. 2002 Jul; 109 7 ; : 1336-41; discussion 1341-2. Efficacy and safety of mitomycin -C in primary trabeculectomy: five-year follow-up. 790 Ward RF, April MM. Int J Pediatr Otorhinolaryngol. 1998 Aug 1O; 44 3 ; : 221-6. Mitomycin-C in the treatment of tracheal cicatrix after tracheal reconstruction. 791 Chung JH, Cosenza MJ, Rahbar R, Metson RB. Otolaryngol Head Neck Surg. 2002 May; 126 5 ; : 468-74. Mitomycin C for the prevention of adhesion formation after endoscopic sinus surgery: a randomized, controlled study. 792 Banthia V, Selesnick SH. Otolaryngol Head Neck Surg. 2003 Jun; 128 6 ; : 882-6. Mitomycin-C in the postsurgical ear canal. 793 Demir T, Turgut B, Akyol N, Ozercan I, Ulas F, Celiker U. Ophthalmologica. 2002 Nov-Dec; 216 6 ; : 438-42. Effects of amniotic membrane transplantation and mitomycin C on wound healing in experimental glaucoma surgery. 794 Bourne IHJ Journal of the Royal Society of Medicine 1990 April 83 Lumbo-Sacral adhesive arachnoiditis. A review and cilostazol.

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