Using probabilistic tractography to target the subcallosal cingulate cortex in patients with treatment resistant depression

Tsolaki, Evangelia; Espinoza, Randall; Pouratian, Nader

doi:10.1016/j.pscychresns.2017.01.006

Cited by 38 publications

(32 citation statements)

References 21 publications

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“…Combining our observations with prior literature, it becomes apparent that the modulatory effect of rTMS of the DLPFC can potentially, directly or indirectly, propagate to the sgACC, depending on individual structural connectivity. The sgACC is an important area for psychiatric treatment as deep brain stimulation (DBS) of this area has shown to have both antidepressant and anti‐compulsive effects (Conen, Matthews, Patel, Anton‐Rodriguez, & Talbot, 2017; De Ridder, Leong, Manning, Vanneste, & Glue, 2017; Dougherty et al, 2016; Kibleur et al, 2017; Tsolaki, Espinoza, & Pouratian, 2017). …”

Section: Discussionmentioning

confidence: 99%

A novel concurrent TMS‐fMRI method to reveal propagation patterns of prefrontal magnetic brain stimulation

Vink

Mandija

Petrov

et al. 2018

Human Brain Mapping

103

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Major depressive disorder (MDD) is a severe mental disorder associated with high morbidity and mortality rates, which remains difficult to treat, as both resistance and recurrence rates are high. Repetitive transcranial magnetic stimulation (TMS) of the left dorsolateral prefrontal cortex (DLPFC) provides a safe and effective treatment for selected patients with treatment‐resistant MDD. Little is known about the mechanisms of action of TMS provided to the left DLPFC in MDD and we can currently not predict who will respond to this type of treatment, precluding effective patient selection. In order to shed some light on the mechanism of action, we applied single pulse TMS to the left DLPFC in 10 healthy participants using a unique TMS‐fMRI set‐up, in which we could record the direct effects of TMS. Stimulation of the DLPFC triggered activity in a number of connected brain regions, including the subgenual anterior cingulate cortex (sgACC) in four out of nine participants. The sgACC is of particular interest, because normalization of activity in this region has been associated with relief of depressive symptoms in MDD patients. This is the first direct evidence that TMS pulses delivered to the DLPFC can propagate to the sgACC. The propagation of TMS‐induced activity from the DLPFC to sgACC may be an accurate biomarker for rTMS efficacy. Further research is required to determine whether this method can contribute to the selection of patients with treatment resistant MDD who will respond to rTMS treatment.

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Section: Discussionmentioning

confidence: 99%

A novel concurrent TMS‐fMRI method to reveal propagation patterns of prefrontal magnetic brain stimulation

Vink

Mandija

Petrov

et al. 2018

Human Brain Mapping

103

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“…In six studies ( 38 – 43 ) where DTI was used in post hoc analysis, the overall mean improvement with DBS was 43.0% (SD = 44.0%) over a mean follow-up period of 8.8 months (SD = 3.1), with 20 out of 30 patients (66.7%) achieving good response (Table 4 ). The overall mean improvement among responders and non-responders were 83.9% (SD = 3.6%) and 8.3% (SD = 15.4%), respectively.…”

Section: Resultsmentioning

confidence: 99%

“…In a good responder, the number of axons within the same pathway activated by the effective electrode, which produced the best therapeutic effects, was significantly higher than the sub-therapeutic electrode contacts ( 42 ). Tsolaki et al ( 38 ) used tractography to identify the optimal site of stimulation within the subcallosal cingulate cortex, and further demonstrated that compared to non-responder, the DBS electrodes in the responder were implanted and stimulation delivered closer to the tractography-optimized target.…”

Section: Resultsmentioning

confidence: 99%

Improving Surgical Outcome Using Diffusion Tensor Imaging Techniques in Deep Brain Stimulation

See

King

2017

Front. Surg.

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IntroductionRecent advances in surgical imaging include the use of diffusion tensor imaging (DTI) in deep brain stimulation (DBS) and provide a detailed view of the white matter tracts and their connections which are not seen with conventional magnetic resonance imaging. Given that the efficacy of DBS depends on the precise and accurate targeting of these circuits, better surgical planning using information obtained from DTI may lead to improved surgical outcome. We aim to review the available literature to evaluate the efficacy of such a strategy.MethodsA search of PubMed was performed to identify all articles using the search terms “(diffusion tractography OR diffusion tensor imaging OR DTI) AND (deep brain stimulation OR DBS).” Studies were included if DTI was used and clinical outcomes were reported.ResultsWe identified 35 studies where the use of DTI in DBS was evaluated. The most studied pathology was movement disorders (17 studies), psychiatric disorders (11 studies), and pain (7 studies). The overall responder rates for tremor reduction was 70.0% (SD = 26.1%) in 69 patients, 36.5% (SD = 19.1%) for obsessive–compulsive disorder in 9 patients, 48.3% (SD = 40.0%) for depression in 40 patients, and 49.7% (SD = 35.1%) for chronic pain in 23 patients.DiscussionThe studies reviewed show that the use of DTI for surgical planning is feasible, provide additional information over conventional targeting methods, and can improve surgical outcome. Patients in whom the DBS electrodes were within the DTI targets experienced better outcomes than those in whom the electrodes were not. Many current studies are limited by their small sample size or retrospective nature. The use of DTI in DBS planning appears underutilized and further studies are warranted given that surgical outcome can be optimized using this non-invasive technique.

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“…Riva-Posse et al used a four-bundle white matter blueprint, which resulted in good clinical outcomes in eight out of 11 patients, which suggests that the use of this method could improve the precision of implantation. Similarly, Tsolaki et al investigated the use of FMRIB Software Library (FSL) probabilistic tractography in SCC-DBS [ 50 ]. Several studies have used other methods to try to specify the optimal stimulation points.…”

Section: Clinical and Preclinical Studies Of Scc Dbs For The Treatmentioning

confidence: 99%

A Decade of Progress in Deep Brain Stimulation of the Subcallosal Cingulate for the Treatment of Depression

Khairuddin

Ngo

Lim

et al. 2020

JCM

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Major depression contributes significantly to the global disability burden. Since the first clinical study of deep brain stimulation (DBS), over 446 patients with depression have now undergone this neuromodulation therapy, and 29 animal studies have investigated the efficacy of subgenual cingulate DBS for depression. In this review, we aim to provide a comprehensive overview of the progress of DBS of the subcallosal cingulate in humans and the medial prefrontal cortex, its rodent homolog. For preclinical animal studies, we discuss the various antidepressant-like behaviors induced by medial prefrontal cortex DBS and examine the possible mechanisms including neuroplasticity-dependent/independent cellular and molecular changes. Interestingly, the response rate of subcallosal cingulate Deep brain stimulation marks a milestone in the treatment of depression. DBS achieved response and remission rates of 64–76% and 37–63%, respectively, from clinical studies monitoring patients from 6–24 months. Although some studies showed its stimulation efficacy was limited, it still holds great promise as a therapy for patients with treatment-resistant depression. Overall, further research is still needed, including more credible clinical research, preclinical mechanistic studies, precise selection of patients, and customized electrical stimulation paradigms.

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Using probabilistic tractography to target the subcallosal cingulate cortex in patients with treatment resistant depression

Cited by 38 publications

References 21 publications

A novel concurrent TMS‐fMRI method to reveal propagation patterns of prefrontal magnetic brain stimulation

A novel concurrent TMS‐fMRI method to reveal propagation patterns of prefrontal magnetic brain stimulation

Improving Surgical Outcome Using Diffusion Tensor Imaging Techniques in Deep Brain Stimulation

A Decade of Progress in Deep Brain Stimulation of the Subcallosal Cingulate for the Treatment of Depression

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