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Eur Neuropsychopharmacol. 2014 Aug;24(8):1229-39. doi: 10.1016/j.euroneuro.2014.05.006. Epub 2014 May 20.

Limbic versus cognitive target for deep brain stimulation in treatment-resistant depression: accumbens more promising than caudate.

Author information

1
University Department of Adult Psychiatry, Guillaume Régnier Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France.
2
Intersector Clinical Psychiatric Research Unit (INSERM U 1084), Psychobiology of Compulsive Disorders Team, Experimental and Clinical Neurosciences Laboratory, Henri Laborit Hospital, University of Poitiers, France.
3
D Villars Ward (Adult Psychiatry), Department of Psychiatry and Neurology, North Hospital, University Hospital, Grenoble, France.
4
Adolescent and Young Adult Assessment Center, Sainte-Anne Hospital, Paris, France.
5
Psychiatry and Medical Psychology Clinic, University Department of Clinical Neuroscience, Pasteur University Hospital, Nice, France.
6
Department of Neurosurgery, Pontchaillou University Hospital, Rennes, France.
7
Department of Neurosurgery, University Hospital, Grenoble, France.
8
Department of Neurosurgery, Pasteur University Hospital, Nice, France.
9
Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.
10
CRICM UPMC/INSERM UMR S 975, CNRS UMR 7225, La Salpêtrière Hospital, Paris, France.
11
Department of Psychiatry, Pitié-Salpêtrière Hospital, Paris, France.
12
University Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France.
13
Inserm U894, Center for Psychiatry and Neuroscience, Paris Descartes University, Paris, France.
14
Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France.
15
Department of Neurology, Pontchaillou University Hosptial, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France.
16
Department of Neurology, Pontchaillou University Hospital, Rennes, France.
17
Functional Neurological Exploration Unit, Pontchaillou University Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France.
18
Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.
19
Department of Nuclear Medicine, Eugène Marquis Center, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France.
20
Clinical Investigation Center (INSERM 0203), Department of Pharmacology, Pontchaillou University Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France. Electronic address: floriannaudet@gmail.com.
21
Clinical Investigation Center (INSERM 0203), Department of Pharmacology, Pontchaillou University Hospital, Rennes, France.

Abstract

High-frequency deep brain stimulation (DBS) represents a major stake for treatment for treatment-resistant depression (TRD). We describe a preliminary trial of DBS of two potential brain targets in chronic TRD: the nucleus accumbens (Acb) and, in the event of failure, the caudate nucleus. Patients were followed for 6 months before surgery (M0). From M1 to M5, they underwent stimulation of the Acb target. PET scans allowed us to track metabolic modifications resulting from this stimulation. The caudate target of nonresponders was stimulated between M5 and M9. Patients then entered an extension phase, in which it was possible to adapt stimulation parameters and treatments. Six patients were included and four were operated on. At M5, none of the patients were either responders or remitters, but we did observe a decrease in Hamilton Depression Rating Scale (HDRS) scores. Three patients were switched to caudate stimulation, but no improvement was observed. During the extension phase, the Acb target was stimulated for all patients, three of whom exhibited a significant response. A decrease in glucose metabolism was observed after Acb stimulation, in the posterior cingulate gyrus, left frontal lobe, superior and medial gyrus, and bilateral cerebellum. An increase in metabolism was observed in the bilateral frontal lobe (superior gyrus), left frontal lobe (medial gyrus), and right limbic lobe (anterior cingulate gyrus). The results of this trial suggest that Acb is a more promising target than the caudate. NCT01569711.

KEYWORDS:

Accumbens; Caudate; Deep brain stimulation; Therapeutic trial; Treatment-resistant depression

PMID:
24950819
DOI:
10.1016/j.euroneuro.2014.05.006
[Indexed for MEDLINE]
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