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Biol Psychiatry. 2014 Dec 15;76(12):963-9. doi: 10.1016/j.biopsych.2014.03.029. Epub 2014 Apr 13.

Defining critical white matter pathways mediating successful subcallosal cingulate deep brain stimulation for treatment-resistant depression.

Author information

1
Department of Psychiatry and Behavioral Sciences, Emory University. Electronic address: privapo@emory.edu.
2
Department of Psychiatry and Behavioral Sciences, Emory University; Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia; Biomedical Imaging Technology Center, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
3
Department of Psychiatry and Behavioral Sciences, Emory University; Departments of Psychiatry and Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
4
Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio.
5
Wallace H. Coulter Department of Biomedical Engineering, Atlanta, Georgia; Department of Neurology, Emory University, Atlanta, Georgia; Department of Neurosurgery, Emory University, Atlanta, Georgia.
6
Department of Psychiatry and Behavioral Sciences, Emory University.
7
Department of Psychiatry and Behavioral Sciences, Emory University; Department of Neurology, Emory University, Atlanta, Georgia.

Abstract

BACKGROUND:

Subcallosal cingulate white matter (SCC) deep brain stimulation (DBS) is an evolving investigational treatment for depression. Mechanisms of action are hypothesized to involve modulation of activity within a structurally defined network of brain regions involved in mood regulation. Diffusion tensor imaging was used to model white matter connections within this network to identify those critical for successful antidepressant response.

METHODS:

Preoperative high-resolution magnetic resonance imaging data, including diffusion tensor imaging, were acquired in 16 patients with treatment-resistant depression, who then received SCC DBS. Computerized tomography was used postoperatively to locate DBS contacts. The activation volume around the contacts used for chronic stimulation was modeled for each patient retrospectively. Probabilistic tractography was used to delineate the white matter tracts traveling through each activation volume. Patient-specific tract maps were calculated using whole-brain analysis. Clinical evaluations of therapeutic outcome from SCC DBS were defined at 6 months and 2 years.

RESULTS:

Whole-brain activation volume tractography demonstrated that all DBS responders at 6 months (n = 6) and 2 years (n = 12) shared bilateral pathways from their activation volumes to 1) medial frontal cortex via forceps minor and uncinate fasciculus; 2) rostral and dorsal cingulate cortex via the cingulum bundle; and 3) subcortical nuclei. Nonresponders did not consistently show these connections. Specific anatomical coordinates of the active contacts did not discriminate responders from nonresponders.

CONCLUSIONS:

Patient-specific activation volume tractography modeling may identify critical tracts that mediate SCC DBS antidepressant response. This suggests a novel method for patient-specific target and stimulation parameter selection.

KEYWORDS:

Antidepressant response; bipolar disorder; deep brain stimulation; diffusion tensor imaging; major depressive disorder; subcallosal cingulate; subgenual cingulate; tractography; treatment-resistant depression

PMID:
24832866
PMCID:
PMC4487804
DOI:
10.1016/j.biopsych.2014.03.029
[Indexed for MEDLINE]
Free PMC Article

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