Anatomical connectivity of the subgenual cingulate region targeted with deep brain stimulation for treatment-resistant depression
Anatomical connectivity of the subgenual cingulate region targeted with deep brain stimulation for treatment-resistant depression
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DOI：
10.1093/cercor/bhm167
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发表时间：
2008-06-01
期刊：
影响因子：
3.7
通讯作者：
Mayberg, H. S.
中科院分区：
文献类型：
--
作者：
Johansen-Berg, H.;Gutman, D. A.;Mayberg, H. S.
慢性脑深部电刺激（DBS）的膝下扣带回白色物质的结果在显着缓解症状，在一些以前的治疗难治性抑郁症患者。刺激的效果可以局部介导或通过皮质或皮质下连接。我们使用纤维束成像来定义可能的连接扣带区域刺激DBS响应患者使用扩散成像数据采集健康对照组。我们根据解剖学连接性定义了前扣带皮层内的2个不同区域：与内侧前额叶和前中扣带皮层紧密连接的膝前区和与丘脑核、杏仁核、下丘脑和眶额皮层紧密连接的膝下区。9例成功接受DBS治疗的患者的电极接触点位置位于该膝下区域。DBS治疗抑郁症靶向的膝下扣带回区域的解剖学连接支持了以下假设：治疗效果是通过对额叶、边缘系统和内脏脑区域的分布式网络的影响来介导的。目前，DBS治疗抑郁症的目标是基于常规磁共振成像中可见的标志。术前获得的用于基于连通性的皮质标测的扩散成像可以提高神经外科手术的靶向。我们假设，在这里描述的分布式网络中具有最大连通性的膝下区域可能被证明是最有效的。
Chronic deep brain stimulation (DBS) of subgenual cingulate white matter results in dramatic remission of symptoms in some previously treatment-resistant depression patients. The effects of stimulation may be mediated locally or via corticocortical or corticosubcortical connections. We use tractography to define the likely connectivity of cingulate regions stimulated in DBS-responsive patients using diffusion imaging data acquired in healthy control subjects. We defined 2 distinct regions within anterior cingulate cortex based on anatomical connectivity: a pregenual region strongly connected to medial prefrontal and anterior midcingulate cortex and a subgenual region with strongest connections to nucleus accumbens, amygdala, hypothalamus, and orbitofrontal cortex. The location of electrode contact points from 9 patients successfully treated with DBS lies within this subgenual region. The anatomical connectivity of the subgenual cingulate region targeted with DBS for depression supports the hypothesis that treatment efficacy is mediated via effects on a distributed network of frontal, limbic, and visceromotor brain regions. At present, targeting of DBS for depression is based on landmarks visible in conventional magnetic resonance imaging. Preoperatively acquired diffusion imaging for connectivity-based cortical mapping could improve neurosurgical targeting. We hypothesize that the subgenual region with greatest connectivity across the distributed network described here may prove most effective.