A systematic review and meta-analysis of deep brain stimulation for depression

Kisely, Steve; Li, Amy; Warren, Nicola; Siskind, Dan

doi:10.1002/da.22746

Cited by 125 publications

(78 citation statements)

References 38 publications

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“…Deep brain stimulation (DBS) is an invasive neurosurgical intervention that involves the continuous delivery of electrical impulses (through typically 2 bilaterally implanted electrodes) to the critical brain area believed to drive the pathological activity. Given that DBS was proven to be a safe and highly effective treatment for controlling the motor symptoms associated with movement disorders [9], clinicians have taken considerable interest in employing DBS in some circuit-based psychiatric disorders, such as major depression [10] and AN [11e14]. Previously, we suggested the DBS of the nucleus accumbens (NAcc), i.e., a subcomponent of the ventral striatum, to be a relatively safe and valuable option for weight restoration in patients with refractory AN [12].…”

Section: Introductionmentioning

confidence: 99%

Deep brain stimulation of the nucleus accumbens for treatment-refractory anorexia nervosa: A long-term follow-up study

Liu

Zhan

et al. 2020

Brain Stimulation

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Background: Given that anorexia nervosa (AN) is a life-threatening mental disorder and has poor clinical outcomes, novel effective treatments are warranted, especially for severe and persistent cases. Objective: To investigate the safety, feasibility, and clinical outcomes of using deep brain stimulation (DBS) of the nucleus accumbens (NAcc) in treatment-refractory AN patients. Methods: A total of 28 women with refractory AN underwent NAcc-DBS and completed this 2-year follow-up study. The clinical outcomes, including body mass index (BMI) and mood, anxiety, and obsessive symptoms, were assessed using a series of psychiatric scales at 6 and 24 months post operation. Results: While no fatalities were reported during this study, 1 patient showed device rejection. The most common short-term side effect observed was varying degrees of pain at the incision sites (n ¼ 22), which usually disappeared 3e4 days following the operation. No severe surgical adverse events were observed. Compared to presurgical levels, significant increases in BMI and improvement in psychiatric scale scores were noted during the 6-month follow-up and were maintained at the 2-year review. Finally, a post-hoc analysis revealed that the NAcc-DBS was less effective for weight restoration in patients with the bingeeating/purge subtype of AN than in those with the restricting subtype (R-AN). Conclusion: Our long-term follow-up study suggests that NAcc-DBS is safe and effective for improving the BMI and psychiatric symptoms of patients with refractory AN. Although NAcc-DBS appears to be more suitable for patients with RAN , strict inclusion criteria must be applied considering surgeryrelated complications.

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Section: Introductionmentioning

confidence: 99%

Deep brain stimulation of the nucleus accumbens for treatment-refractory anorexia nervosa: A long-term follow-up study

Liu

Zhan

et al. 2020

Brain Stimulation

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“…Deep brain stimulation for the treatment of major depressive disorder (MDD) is a rather new indication offering hope for some of these treatment resistant patients. A first uncontrolled case series studied effects of DBS to Brodman area 25 (cg25, later termed SCG = subgenual cingulate gyrus) (Mayberg et al, 2005) and the scg target is likely the most frequently implanted structure in this disease (Kisely et al, 2018). Other target regions have been researched (ALIC = anterior limb of the internal capsule; vc/vs = ventral capsule ventral striatum for which case series exist and some smaller case series or even single case reports for structures like inferior thalamic peduncle, habenula and others).…”

Section: Introductionmentioning

confidence: 99%

“…Other target regions have been researched (ALIC = anterior limb of the internal capsule; vc/vs = ventral capsule ventral striatum for which case series exist and some smaller case series or even single case reports for structures like inferior thalamic peduncle, habenula and others). For a review on the topic refer to (Hariz et al, 2013; Kisely et al, 2018). Two pivotal randomized controlled multicentric trials were recently stopped after futility analysis (Dougherty et al, 2015; Holtzheimer et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Tractography-assisted deep brain stimulation of the superolateral branch of the medial forebrain bundle (slMFB DBS) in major depression

Coenen

Sajonz

Reisert

et al. 2018

NeuroImage: Clinical

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BackgroundDeep brain stimulation (DBS) of the superolateral branch of the medial forebrain bundle (slMFB) emerges as a - yet experimental - treatment for major depressive disorder (MDD) and other treatment refractory psychiatric diseases. First experiences have been reported from two open label pilot trials in major depression (MDD) and long-term effectiveness for MDD (50 months) has been reported.ObjectiveTo give a detailed description of the surgical technique for DBS of the superolateral branch of the medial forebrain bundle (slMFB) in MDD.MethodsSurgical experience from bilateral implantation procedures in n = 24 patients with MDD is reported. The detailed procedure of tractography-assisted targeting together with detailed electrophysiology in 144 trajectories in the target region (recording and stimulation) is described. Achieved electrode positions were evaluated based on postoperative helical CT and fused to preoperative high resolution anatomical magnetic resonance imaging (MRI; Philips Medical Systems, Best, Netherlands), including the pre-operative diffusion tensor imaging (DTI) tractographic information (StealthViz DTI, Medtronic, USA; Framelink 5.0, Medtronic, USA). Midcommissural point (MCP) coordinates of effective contact (EC) location, together with angles of entry into the target region were evaluated. To investigate incidental stimulation of surrounding nuclei (subthalamic nucleus, STN; substantia nigra, SNr; and red nucleus, RN) as a possible mechanism, a therapeutic triangle (TT) was defined, located between these structures (based on MRI criteria in T2) and evaluated with respect to EC locations.ResultsBilateral slMFB DBS was performed in all patients. We identified an electrophysiological environment (defined by autonomic reaction, passive microelectrode recording, acute effects and oculomotor effects) that helps to identify the proper target site on the operation table. Postoperative MCP-evaluation of effective contacts (EC) shows a significant variability with respect to localization. Evaluation of the TT shows that responders will typically have their active contacts inside the triangle and that surrounding nuclei (STN, SNr, RN) are not directly hit by EC, indicating a predominant white matter stimulation. The individual EC position within the triangle cannot be predicted and is based on individual slMFB (tractography) geometry. There was one intracranial bleeding (FORESEE I study) during a first implantation attempt in a patient who later received full bilateral implantation. Typical oculomotor side effects are idiosyncratic for the target region and at inferior contacts.ConclusionThe detailed surgical procedure of slMFB DBS implantation has not been described before. The slMFB emerges as an interesting region for the treatment of major depression (and other psychiatric diseases) with DBS. So far it has only been successfully researched in open label clinical case series and in 15 patients published. Stimulation probably achieves its effect through direct white-matter modulation of slMFB...

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“…Thus, we believe that those patients resistant to current standards of care might benefit from the use of novel neurotechnologies like DBS. However, randomized control trials of using continuous DBS of pre-selected brain locations to treat major depression, while relatively efficacious, did not yield statistically significant results (Kisely et al, 2018). Difficulties in treating depression with DBS may be related to the complex and heterogeneous nature of this disorder.…”

Section: A Randomized Controlled Trial Of Personalized Adaptive-loop mentioning

confidence: 99%

Proceedings of the Seventh Annual Deep Brain Stimulation Think Tank: Advances in Neurophysiology, Adaptive DBS, Virtual Reality, Neuroethics and Technology

Ramirez‐Zamora

Giordano

Gündüz

et al. 2020

Front. Hum. Neurosci.

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A systematic review and meta-analysis of deep brain stimulation for depression

Abstract: DBS may show promise for treatment-resistant depression but remains an experimental treatment until further data are available.

Cited by 125 publications

References 38 publications

Deep brain stimulation of the nucleus accumbens for treatment-refractory anorexia nervosa: A long-term follow-up study

Deep brain stimulation of the nucleus accumbens for treatment-refractory anorexia nervosa: A long-term follow-up study

Tractography-assisted deep brain stimulation of the superolateral branch of the medial forebrain bundle (slMFB DBS) in major depression

Proceedings of the Seventh Annual Deep Brain Stimulation Think Tank: Advances in Neurophysiology, Adaptive DBS, Virtual Reality, Neuroethics and Technology

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