Defining critical white matter pathways mediating successful subcallosal cingulate deep brain stimulation for treatment-resistant depression.
Defining critical white matter pathways mediating successful subcallosal cingulate deep brain stimulation for treatment-resistant depression.
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DOI：
10.1016/j.biopsych.2014.03.029
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发表时间：
2014-12-15
影响因子：
10.6
通讯作者：
Mayberg HS
中科院分区：
文献类型：
--
作者：
Riva-Posse P;Choi KS;Holtzheimer PE;McIntyre CC;Gross RE;Chaturvedi A;Crowell AL;Garlow SJ;Rajendra JK;Mayberg HS
胼胝体下扣带回白色物质（SCC）的脑深部电刺激（DBS）是一种正在发展的治疗抑郁症的研究。作用机制被假设为涉及在结构上定义的参与情绪调节的大脑区域网络内的活动调制。扩散张量成像（DTI）被用来模拟该网络中的白色物质连接，以识别那些对SCC DBS成功的抗抑郁反应至关重要的连接。术前高分辨率MRI数据，包括DTI，在16例难治性抑郁症患者中获得，然后接受SCC DBS。术后使用计算机断层扫描定位DBS触点。回顾性地为每例患者建模用于慢性刺激的有源触点周围的激活体积。概率纤维束成像用于描绘穿过每个激活体积的白色物质束。使用全脑分析计算患者特异性束图。SCC DBS治疗结局的临床评价定义为6个月和2年。全脑激活体积纤维束成像（AVT）显示，6个月（n=6）和2年（n=12）时所有DBS反应者共享双侧通路，从激活体积到（1）内侧额叶皮层（通过小镊子和钩束），（2）喙侧和背侧扣带皮层（通过扣带束），以及（3）皮质下核。无应答者并不总是表现出这些联系。活动触点的特定解剖坐标不能区分应答者和非应答者。患者特异性AVT建模可以识别介导SCC DBS抗抑郁反应的关键血管束。这提出了一种用于患者特异性目标和刺激参数选择的新方法。
Deep brain stimulation (DBS) of subcallosal cingulate white matter (SCC) is an evolving investigational treatment for major 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 (DTI) was used to model white matter connections within this network to identify those critical for successful antidepressant response to SCC DBS. Pre-operative high-resolution MRI data, including DTI, were acquired in 16 patients with treatment-resistant depression who then received SCC DBS. Computerized tomography was used post-operatively to locate DBS contacts. The activation volume around the active contacts used for chronic stimulation was modeled for each patient retrospectively. Probabilistic tractography was used to delineate the white matter tracts that traveled 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. Whole brain activation volume tractography (AVT) demonstrated that all DBS responders at six 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. Non-responders did not consistently show these connections. Specific anatomical coordinates of the active contacts did not discriminate responders from non-responders. Patient-specific AVT modeling may identify critical tracts that mediate SCC DBS antidepressant response. This suggests a novel method for patient-specific target and stimulation parameter selection.
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影响因子：
4
作者：
Chaturvedi A;Luján JL;McIntyre CC
通讯作者：
McIntyre CC
影响因子：
4.8
作者：
Lujan, J. Luis;Chaturvedi, Ashutosh;Malone, Donald A.;Rezai, Ali R.;Machado, Andre G.;McIntyre, Cameron C.
通讯作者：
McIntyre, Cameron C.
影响因子：
7.7
作者：
Lujan, J. Luis;Chaturvedi, Ashutosh;Choi, Ki Sueng;Holtzheimer, Paul E.;Gross, Robert E.;Mayberg, Helen S.;McIntyre, Cameron C.
通讯作者：
McIntyre, Cameron C.
影响因子：
5.7
作者：
Jenkinson, M;Bannister, P;Smith, S
通讯作者：
Smith, S
影响因子：
10.6
作者：
Gutman, David A.;Holtzheimer, Paul E.;Behrens, Timothy E. J.;Johansen-Berg, Heidi;Mayberg, Helen S.
通讯作者：
Mayberg, Helen S.