Deep brain stimulation of the posterior gyrus rectus region for treatment resistant depression
Deep brain stimulation of the posterior gyrus rectus region for treatment resistant depression
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DOI：
10.1016/j.jad.2016.01.022
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发表时间：
2016-04-01
影响因子：
6.6
通讯作者：
Draganski, Bogdan
中科院分区：
文献类型：
--
作者：
Accolla, Ettore A.;Aust, Sabine;Draganski, Bogdan
背景：深部脑刺激（DBS）是药物治疗失败时重度抑郁症的替代对症治疗方法。膝下扣带回布罗德曼区域 25 (CG-25) 是电极植入最广泛使用的目标之一。鉴于 DBS 后临床结果的差异，迫切需要深入研究大脑解剖结构和功能，以便在手术前提供准确可靠的预后。方法：我们研究了 5 名计划接受针对 CG-25 的 DBS 的难治性重度抑郁症患者。手术前，我们为每位患者采集了高分辨率磁共振 (MR) 扩散加权图像，然后在术后进行 MRI 进行电极定位。为了估计主动接触位置的个体解剖连接模式，我们在个体内进行了概率扩散纤维束成像。然后，我们将连接模式与标准化临床测试评估的结果相关联。比较了 DBS 反应者和无反应者之间的连接结果。结果：我们在一名患者中观察到，在双侧后直回 DBS 治疗（而不是最初靶向的 CG-25）后，临床反应良好。其余四名患有 CG-25 DBS 的患者被认为是无反应者。在该病例中，我们证明了刺激区域与内侧前额叶皮层 (mPFC) 的强连通性，这与无反应者的 mPFC 连接性较低形成鲜明对比。局限性：需要在更大的队列中进行确认。结论：我们建议将后直回作为重度抑郁症 DBS 的可行替代新目标。目标区域和 mPFC 之间的高连通性支持了该区域在涉及情绪处理的大脑网络中的关键作用。 (C) 2016 Elsevier B.V. 保留所有权利。
Background: Deep brain stimulation (DBS) represents an alternative symptomatic treatment for major depressive disorder in case of failure of pharmacotherapy. The sub-genual cingulate-Brodmann area 25 (CG-25), is one of the most widely used targets for electrode implantation. Given the diverging clinical outcome after DBS, there is a pressing need for in-depth study of brain anatomy and function allowing accurate and reliable prognosis before surgery.Methods: We studied five treatment-resistant major depressive disorder patients planned to undergo DBS targeting the CG-25. Before surgery, we acquired high-resolution magnetic resonance (MR) diffusion-weighted images for each patient followed by post-surgery MRI for electrode localization. To estimate individual anatomical connectivity pattern of the active contact location we performed probabilistic diffusion tractography intra-individually. We then correlated connectivity patterns with outcome assessed with standardized clinical tests. Connectivity results were compared between DBS responders and non-responders.Results: We observed in one patient an excellent clinical response after DBS of the bilateral posterior gyrus rectus rather than the initially targeted CG-25. The remaining four patients with DBS of the CG-25 were considered as non-responders. In the case patient, we demonstrate a strong connectivity of the stimulated regions to the medial prefrontal cortex (mPFC), which contrasted to the lower mPFC connectivity in non-responders.Limitations: Confirmation in larger cohorts is needed.Conclusions: We propose the posterior gyrus rectus as viable alternative new target for DBS in major depressive disorder. High connectivity between target and mPFC supports the pivotal role of this region in brain networks involved in mood processing. (C) 2016 Elsevier B.V. All rights reserved.