Paul Lesperance

• MD, MSc, FRCP
• Professor at Université de Montréal

Objective: This study investigated spaced transcranial direct current stimulation for major depressive disorder, focusing on feasibility. Methods: In a prospective open-label study, 30 participants with major depressive disorder were enrolled to receive a 50-session transcranial direct current stimulation (tDCS) treatment over 2 weeks. The feasibil...

Vagal neurostimulation (VNS) is used for the treatment of epilepsy and major medical-refractory depression. VNS has neuropsychiatric functions and systemic anti-inflammatory activity. The objective of this study is to measure the clinical efficacy and impact of VNS modulation in depressive patients. Six patients with refractory depression were enro...

About a third of patients suffering from major depression develop treatment-resistant depression (TRD). Although repetitive transcranial magnetic stimulation (rTMS) and intravenous ketamine have proven effective for the management of TRD, many patients remain refractory to treatment. We present the case of a patient suffering from bipolar TRD. The...

Background The role of inflammation in major depression is increasingly recognized. Vagal neurostimulation (VNS) is used for the treatment of epilepsy and major medical-refractory depression. VNS has neuropsychiatric functions and systemic anti-inflammatory activity. The objective of this study is to measure the clinical efficacy and assess the imp...

Background Alcohol use disorder is highly prevalent and has important economical, societal, psychiatric, and medical consequences. All currently approved therapeutic approaches targeting alcohol dependence have relatively modest effects and high relapse rates. Recent evidence suggests that ketamine may be an effective intervention to treat alcohol...

Intermittent theta burst stimulation (iTBS) using 600 pulses is an effective and FDA-cleared transcranial magnetic stimulation (TMS) protocol for major depressive disorder (MDD). Prolonged iTBS (piTBS) using 1,800 pulses could increase the effectiveness of TMS for MDD, but its real-world effectiveness is still debated. We assessed the safety, toler...

Treatment resistant depression is challenging because patients who fail their initial treatments often do not respond to subsequent trials and their course of illness is frequently marked by chronic depression. Repetitive transcranial magnetic stimulation (rTMS) is a well-established treatment alternative, but there are several limitations that dec...

Citation: Noiseux, C.; Miron, J.-P.; Desbeaumes Jodoin, V.; Chu, T.R.; Chouinard, S.; Lespérance, P. Repetitive Transcranial Magnetic Stimulation for Major Depressive Disorder Comorbid with Huntington's Disease: A Case Report. NeuroSci 2021, 2, 400-404. https://doi. Abstract: Huntington's disease (HD) is a rare genetic disorder resulting in progres...

BACKGROUND Major depressive disorder (MDD) is now the first cause of disability worldwide. So far, no validated and scalable biomarker has been identified to help with response prediction to antidepressant treatment. Cardiac biomarkers such as heart rate variability (HRV) have been studied in MDD, but few studies have examined its potential use for...

Background: Pathological rumination is a cardinal symptom of major depressive disorder (MDD), resulting from default-mode network (DMN) hyperactivity. Higher baseline rumination have been associated with onset of MDD, and therapies aiming at reducing rumination lead to clinical improvement. Repetitive transcranial magnetic stimulation (rTMS) is eff...

Repetitive transcranial magnetic stimulation (rTMS) is a safe and well-tolerated intervention for major depressive disorder (MDD). Over 150 randomized controlled trials (RCTs) have been carried out, and its efficacy has been confirmed in dozens of meta-analyses. Real world data has also confirmed the effectiveness of rTMS for MDD in clinical practi...

We previously found normal polysomnographic (PSG) sleep efficiency, increased slow wave sleep (SWS) and a blunted melatonin secretion in women with premenstrual dysphoric disorder (PMDD) compared to controls. Here, we investigated the effects of exogenous melatonin in five patients previously studied. They took 2 mg of slow-release melatonin 1 hour...

Background This work describes the clinical symptoms associated with end of service (EOS) of the batteries of vagus nerve stimulation (VNS) generators in treatment-resistant depression (TRD). Because neurostimulator software may not provide reliable information on battery depletion, careful monitoring of clinical symptoms during the EOS period is a...

This work describes a clinical case in which we used telemedicine to monitor at-home ketamine treatment in TRD. Ketamine has been shown to be a promising and safe treatment for TRD in elderly patients. However, the COVID-19 pandemic is clearly impacting the world and this disease is recognized as being particularly dangerous for the elderly and vul...

Introduction: Recent studies have revealed a possible link between heart rate variability (HRV) and major depressive disorder (MDD), with decreased HRV in MDD compared with healthy subjects. Corrected Q-T interval (QTc) has been suggested to represent an indirect estimate of HRV, as QTc length is inversely correlated to parasympathetic activity in...

Introduction Heart rate variability (HRV) and depression are correlated, suggesting a pathophysiological relationship between depressive symptoms and the modulation of cardiovagal activity. It has been suggested that the corrected Q-T interval (QTc) represents an indirect estimate of HRV. Furthermore, recent depression research has emphasized the i...

Introduction The relationship between sleep and depression is complex and well-established. About three quarter of patients with major depressive disorder (MDD) have comorbid sleep dysregulations. Current research has emphasized the importance of establishing biologically relevant subtypes of MDD with treatment specificity and prognostic value. Pol...

Objective: Major depressive disorder (MDD) is a prevalent condition in older adults. Although antidepressant drugs are commonly prescribed, efficacy is variable, and older patients are more prone to side effects. Repetitive transcranial magnetic stimulation (rTMS) is an alternative therapy used increasingly in the treatment of MDD. Even though rec...

No abstract available

Background: Treatment-resistant depression (TRD) is a serious chronic condition disabling patients functionally and cognitively. Chronic vagus nerve stimulation (VNS) is recognized for the management of TRD, but few studies have examined its long-term effects on cognitive dysfunction in unipolar and bipolar resistant depression. Objective: The p...

Introduction La neurostimulation du nerf vague (SNV) est utilisée en neurochirurgie pour le traitement de l’épilepsie et de la dépression majeure médico-réfractaires. La SNV, en plus de stimuler électriquement le cerveau, exercerait aussi des effets systémiques anti-inflammatoires. Or, le rôle de l’inflammation dans la dépression majeure est de plu...

Depression is one of the most prevalent psychiatric disorders among opioid-dependent individuals. Clinical trials testing selective serotonin reuptake inhibitors among depressed patients on methadone maintenance therapy (MMT) failed to show efficacy, whereas those on tricyclic antidepressants produced mixed results with potential for cardiotoxicity...

Chronic tic disorders (TD) are associated with a number of psychological problems such as attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive behavior (OCB), oppositional-defiant disorder (ODD) as well as anxious and depressive symptoms. ODD is often considered a risk factor for many psychological symptoms and recent work suggests...

Objectives: Treatment-resistant depression (TRD) carries a major burden on those affected by this disease and significantly impacts their quality of life (QOL). Vagus nerve stimulation (VNS) has showed promising results on symptoms, but its impact on QOL remains underresearched. This study aims to evaluate the long-term effects of VNS on both QOL...

Background: Electroconvulsive therapy is indicated in cases of catatonic schizophrenia following a failure of the challenge test with lorazepam or Zolpidem®. Some patients need maintenance treatment with ECT. Repetitive Transcranial Magnetic Stimulation (rTMS) and anodal Transcranial direct-current stimulation (tDCS) might be effective against cat...

Background: Occipital nerve stimulation (ONS) has been used for the treatment of neuropathic pain conditions and could be a therapeutic approach for refractory cervicogenic headache (CeH). Aim: The aim of this study is to assess the efficacy and safety of unilateral ONS in patients suffering from refractory CeH. Methods: We conducted a retrosp...

Background: Chronic substance use can disrupt the reward function of the anterior cingulate cortex (ACC), biasing the ACC to favor goal-directed behaviors that converge on drug use. Here we used multimodal neuroimaging methods to ask whether modulating reward-related signaling in the ACC can reverse the atypical valuation of nondrug and drug rewar...

Vagal nerve stimulation (VNS) therapy is an effective adjunctive treatment for chronic or recurrent treatment resistant depression. Although considered a safe procedure, increasing output current can be associated with stimulation induced side effects. We report the first case of dry cough induced by speech and mild exercise, occurring in the off m...

Objective: Tic disorders such as Gilles-de-la-Tourette syndrome (TS) are associated with difficulties in withholding movements and sometimes inappropriate actions. The present study examined whether these disorders lead to a specific difficulty in withholding preprogrammed voluntary movements irrespective of decisions on whether or not to move. Met...

In chronic tic disorders such as Tourette syndrome (TS), tics often appear between 4 and 8 years but they can also appear in early childhood, a period in which symptom expression may be affected by early brain development. The present study examined whether symptom expression in early-onset TS was distinct from that observed in TS with a later onse...

Background: Chronic vagus nerve stimulation (VNS) is a recognized treatment for refractory epilepsy and depression. The vagus nerve projects to several brainstem autonomic structures. As pupillary measures are an easy and non-invasive method to evaluate autonomic functioning, we used resting diameter and light reflex measures to investigate the in...

Gilles de la Tourette syndrome (TS) and chronic tic disorder (CT) are often associated with a variety of behavioral comorbidities including attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive behavior (OCB), oppositional-defiant disorder (ODD) and temper outbursts. ODD is often associated with ADHD but its links to other symptoms...

Objective: To assess the effect of duloxetine on ADHD in adults. Method: In a 6-week double-blind trial, 30 adults with ADHD received placebo or duloxetine 60 mg daily. The Conners’ Adult ADHD Rating Scale (CAARS) and the Clinical Global Impression Scales (CGI) were used to assess symptom severity and clinical improvement. The Hamilton Anxiety Rati...

Women with premenstrual dysphoric disorder (PMDD) experience mood deterioration and altered circadian rhythms during the luteal phase (LP) of their menstrual cycles. Disturbed circadian rhythms may be involved in the development of clinical mood states, though this relationship is not fully characterized in PMDD. We therefore conducted an extensive...

Women with premenstrual dysphoric disorder (PMDD) experience disturbed mood, altered melatonin circadian rhythms, and frequent reports of insomnia during the luteal phase (LP) of their menstrual cycle. In this study we aimed to investigate nocturnal polysomnographic (PSG) sleep across the menstrual cycle in PMDD women and controls. Seven PMDD women...

The first report of a tic disorder was made as early as in 1825 by Jean Marc Gaspard Itard, a French neurologist. He described the case of a French noblewoman, Marquise de Dampierre, who displayed involuntary movements and coprolalia. At the end of the nineteenth century, Armand Trousseau and Georges Gilles de la Tourette published a more complete...

To document the short-term efficacy of omega-3 supplementation in reducing depressive symptoms in patients experiencing a major depressive episode (MDE). Inclusive, double-blind, randomized, controlled, 8-week, parallel-group trial, conducted October 17, 2005 through January 30, 2009 in 8 Canadian academic and psychiatric clinics. Adult outpatients...

To test the association between Tourette syndrome (TS) and genetic variants in genomic loci MEIS1, MAP2K5/LBXCOR1, and BTBD9, for which genome-wide association studies in restless legs syndrome and periodic limb movements during sleep revealed common risk variants. Case-control association study. Movement disorder clinic in Montreal. Subjects We ty...

Tics disorders and Tourette syndrome are commonly encountered in clinical practice. Currently, a vast number of behavioural, pharmacological and surgical treatments are available. Relevant and recent articles about clinical features, neurobiology and treatment of tic disorders and Tourette syndrome were reviewed and summarized. Tic disorders and To...

The neurotensin gene (NTS), a known dopamine modulator, is located within the candidate region for the first genetic locus of restless legs syndrome (RLS1) on chromosome 12q. Though no causative mutation was found in selected patients in a previous mutation analysis, the involvement of NTS in RLS cannot be completely excluded as a potential positio...

Huntington's disease (HD) is a neurodegenerative disease affecting the striatum and associated with deficits in voluntary movement in early stages. The final portion of aiming movements is particularly affected in HD and one hypothesis is that this deficit is linked to attention or terminal control requirements. Sixteen patients with early HD and 1...

The goal of the present study was to determine whether postural control is affected in Gilles-de-la-Tourette syndrome (TS). Center of pressure (COP) displacements were recorded in children with TS and unaffected siblings in three conditions using a force platform: (1) Eyes-Open, (2) Eyes-Closed, (3) One-Leg standing with eyes open. The COP range an...

Previous studies have found association and linkage between Tourette syndrome (TS) and markers at the 11q24 region, mainly with markers D11S1377 and D11S933. In order to determine if these positive findings could be replicated in our sample, we undertook a family-based association study in 199 French Canadian TS nuclear families. We genotyped 572 i...

Restless legs syndrome (RLS) and Tourette's syndrome (TS) share some common features, including the phenomenology of sensations relieved by movements, but few studies have examined the links between RLS and TS. We examined RLS and other TS comorbidities in 144 probands with TS or chronic tics and their parents. RLS was present in 10% of probands an...

Tourette syndrome (TS) is a complex neuropychiatric disorder with a strong genetic basis. Although no specific susceptibility genes have been identified for TS, cytogenetic studies in selected cases suggest the existence of a predisposing gene located in the 7q31 chromosomal region. In order to test the hypothesis of a possible relationship between...

Tourette syndrome (TS) is a genetically complex disorder for which no causative genes have been unequivocally identified. Nevertheless, a number of molecular genetic studies have investigated several candidate genes, particularly those implicated in dopamine modulation. The results of these studies were inconclusive, which may be due, at least in p...

A rare disorder, neuroacanthocytosis is characterized by chorea, tics, subcortical cognitive impairments, and acanthocytosis. This study presents two men with neuroacanthocytosis who were initially diagnosed with schizophrenia. Findings revealed the intricate relationships between movement disorders and psychosis and the importance of accurate diag...

Our aim was to compare the circadian phase characteristics of healthy adolescent and young adult males in a naturalistic summertime condition. A total of 19 adolescents (mean age 15.7 years) and 18 young adults (mean age 24.5 years) with no sleep problems took part in this study. Two-night polysomnographic (PSG) sleep recordings and 24h secretion p...

Thirty-four patients who presented with excessive daytime sleepiness (EDS) and who showed an elevated number of periodic leg movements during sleep (PLMS) were studied. None of these patients reported other symptoms or presented sleep laboratory manifestations of narcolepsy or of breathing disorders during sleep. A diagnosis of restless leg syndrom...

This study was designed to test the hypothesis that bright light (BL) can have a stimulating effect on vigilance even in the absence of suppression of melatonin secretion and that this effect can be detected when measured in subjects with low vigilance levels. Seven normal subjects were exposed to bright-white light (BL group) and seven to dim-red...

Patients with restless leg syndrome (RLS) complain of motor restlessness, usually occurring while they rest in the evening. Two immobilization tests have been described to assess leg restlessness in these patients. In the first test, the patient sits in bed with his or her legs outstretched while electromyograms are recorded from right and left ant...

One hundred thirty-three cases of restless legs syndrome (RLS), diagnosed with criteria recently formulated by an international study group, were studied by questionnaire and with all-night polysomnographic recordings. Results show that RLS starts at a mean age of 27.2 years and before age 20 in 38.3% of patients. Symptoms often appear in one leg o...