A multicenter pilot study of subcallosal cingulate area deep brain stimulation for treatment-resistant depression

Abstract

Object. Deep brain stimulation (DBS) has been recently investigated as a treatment for major depression. One of the proposed targets for this application is the subcallosal cingulate gyrus (SCG). To date, promising results after SCG DBS have been reported by a single center. In the present study the authors investigated whether these findings may be replicated at different institutions. They conducted a 3-center prospective open-label trial of SCG DBS for 12 months in patients with treatment-resistant depression.Methods. Twenty-one patients underwent implantation of bilateral SCG electrodes. The authors examined the reduction in Hamilton Rating Scale for Depression (HRSD-17) score from baseline (RESP50).Results. Patients treated with SCG DBS had an RESP50 of 57% at 1 month, 48% at 6 months, and 29% at 12 months. The response rate after 12 months of DBS, however, increased to 62% when defined as a reduction in the baseline HRSD-17 of 40% or more. Reductions in depressive symptomatology were associated with amelioration in disease severity in patients who responded to surgery.Conclusions. Overall, findings from this study corroborate the results of previous reports showing that outcome of SCG DBS may be replicated across centers. 315Abbreviations used in this paper: CGI-S = Clinical Global Impression-Severity; DBS = deep brain stimulation; HRSD-17 = 17-item Hamilton Rating Scale for Depression; RESP50 = a minimum 50% reduction in the HRSD-17 score from baseline; SCG = subcallosal cingulate gyrus; TRD = treatment-resistant depression.

EEG Power Asymmetry and Functional Connectivity as a Marker of Treatment Effectiveness in DBS Surgery for Depression

“…Figure 1 shows the anatomical location of the subgenual cingulate gyrus. Electrode positions have been extensively discussed in previous publications (Hamani et al, 2009(Hamani et al, , 2011Laxton et al, 2013;Lozano et al, 2012).…”

Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases

“…First, the patient populations treated with invasive or noninvasive brain stimulation are starting to converge. For example, the primary indication for TMS is depression, and the primary indication for DBS is Parkinson's disease, but DBS is being investigated as a treatment for depression, and TMS is being investigated as a treatment for Parkinson's disease (4,(20)(21)(22)(23)(24)(25). Second, although therapeutic mechanisms remain unknown, invasive and noninvasive brain stimulation share important properties.…”

Neurostimulation for traumatic brain injury

“…In fact, TBI patients commonly show symptoms of depression as measured by multiple depression scales 125 and major depressive disorder is reported as the most common psychiatric illness resulting from TBI. 10,58 As DBS has shown encouraging results in depression in both humans and animal models, 50,85,86 it may be a useful treatment option for TBI survivors suffering from depression. Other potential sequelae of TBI, such as deficits in memory and arousal, may also be amenable to DBS.…”

“…A multicenter study of SCC DBS yielded more modest results, with 29% of 21 patients achieving responder status at 12 months. 85 Multiple clinical trials in the US, Canada, and Europe are underway to continue the evaluation of SCC DBS in TRD. The anterior limb of the internal capsule and adjacent ventral striatum/nucleus accumbens, structures that have been shown to have significant overlap with the SCC in connections to the medial temporal lobes, frontal limbic cortices, and autonomic subcortical structures, 49 have also been the focus of several investigations as a DBS target for TRD.…”