Potential surgical targets for deep brain stimulation in treatment-resistant depression

Hauptman, Jason S.; DeSalles, Antonio; Espinoza, Randall; Sedrak, Mark; Ishida, Warren

doi:10.3171/foc/2008/25/7/e3

Cited by 82 publications

(45 citation statements)

References 68 publications

(113 reference statements)

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“…Neurostimulation treatments attempt to correct aberrant neural transmission in these networks by delivering electric or magnetic stimulation to implicated brain regions. Some therapies target structures directly, including subgenual anterior cingulate (deep brain stimulation, DBS), ventral striatum (DBS), and dorsolateral prefrontal cortex (transcranial magnetic and direct-current stimulation, TMS and tDCS, respectively; [Hauptman et al 2008;De Raedt et al 2014…”

Section: Introductionmentioning

confidence: 99%

Desynchronization and Plasticity of Striato-frontal Connectivity in Major Depressive Disorder

et al. 2015

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Major depressive disorder (MDD) is associated with dysfunctional corticolimbic networks, making functional connectivity studies integral for understanding the mechanisms underlying MDD pathophysiology and treatment. Resting-state functional connectivity (RSFC) studies analyze patterns of temporally coherent intrinsic brain activity in "resting-state networks" (RSNs). The default-mode network (DMN) has been of particular interest to depression research; however, a single RSN is unlikely to capture MDD pathophysiology in its entirety, and the DMN itself can be characterized by multiple RSNs. This, coupled with conflicting previous results, underscores the need for further research. Here, we measured RSFC in MDD by targeting RSNs overlapping with corticolimbic regions and further determined whether altered patterns of RSFC were restored with electroconvulsive therapy (ECT). MDD patients exhibited hyperconnectivity between ventral striatum (VS) and the ventral default-mode network (vDMN), while simultaneously demonstrating hypoconnectivity with the anterior DMN (aDMN). ECT influenced this pattern: VS-vDMN hyperconnectivity was significantly reduced while VS-aDMN hypoconnectivity only modestly improved. RSFC between the salience RSN and dorsomedial prefrontal cortex was also reduced in MDD, but was not affected by ECT. Taken together, our results support a model of ventral/dorsal imbalance in MDD and further suggest that the VS is a key structure contributing to this desynchronization.

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Section: Introductionmentioning

confidence: 99%

Desynchronization and Plasticity of Striato-frontal Connectivity in Major Depressive Disorder

et al. 2015

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“…The targeted brain structures for Parkinson's disease are subthalamic nuclei, for dystonia the globus pallidus internus, for cluster headache the ipsilateral ventroposterior hypothalamus, for OCD the anterior limb of the capsula interna, and for depression the subthalamic nucleus, internal globus pallidus, ventral internal capsule/ventral striatum, subgenual cingulate region, nucleus accumbens (NA), inferior thalamic peduncle, and the lateral habenula [47,52] . There are several physiological methods for verification of the anatomical target, including microelectrode and semi-microelectrode recording of the spontaneous and evoked electrical activity, or macro- stimulation.…”

Section: Neurobiology Of Dbsmentioning

confidence: 99%

The Application of Vagus Nerve Stimulation and Deep Brain Stimulation in Depression

Mohr

Rodríguez

A³

et al. 2011

Neuropsychobiology

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Despite the progress in the pharmacotherapy of depression, there is a substantial proportion of treatment-resistant patients. Recently, reversible invasive stimulation methods, i.e. vagus nerve stimulation (VNS) and deep brain stimulation (DBS), have been introduced into the management of treatment-resistant depression (TRD). VNS has already received regulatory approval for TRD. This paper reviews the available clinical evidence and neurobiology of VNS and DBS in TRD. The principle of VNS is a stimulation of the left cervical vagus nerve with a programmable neurostimulator. VNS was examined in 4 clinical trials with 355 patients. VNS demonstrated steadily increasing improvement with full benefit after 6–12 months, sustained up to 2 years. Patients who responded best had a low-to-moderate antidepressant resistance. However, the primary results of the only controlled trial were negative. DBS involves stereotactical implantation of electrodes powered by a pulse generator into the specific brain regions. For depression, the targeted areas are the subthalamic nucleus, internal globus pallidus, ventral internal capsule/ventral striatum, the subgenual cingulated region, and the nucleus accumbens. Antidepressant effects of DBS were examined in case series with a total number of 50 TRD patients. Stimulation of different brain regions resulted in a reduction of depressive symptoms. The clinical data on the use of VNS and DBS in TRD are encouraging. The major contribution of the methods is a novel approach that allows for precise targeting of the specific brain areas, nuclei and circuits implicated in the etiopathogenesis of neuropsychiatric disorders. For clinical practice, it is necessary to identify patients who may best benefit from VNS or DBS.

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“…For example, there is some evidence that NAC stimulation may have an antidepressant effect. 10,11 It could be argued that because our patient had symptoms of depression, NAC stimulation had a mood-modulating effect that had a positive impact on the patient's experience of pain. It is important to note, however, that the patient had relief from her depressive symptoms prior to surgery through ECT, that she was responding well to selective serotonin reuptake inhibitor medication at the time of DBS implantation, and that her subjective experience of depression was unchanged following DBS.…”

Section: Deep Brain Stimulation Of the Nucleus Accumbens For Painmentioning

confidence: 99%

“…10,11 Based on increasing evidence that the NAC also mediates pain processing, we hypothesized it might be an effective target for CPSP.…”

Section: T He Efficacy Of Deep Brain Stimulation (Dbs)mentioning

confidence: 99%

The Nucleus Accumbens as a Potential Target for Central Poststroke Pain

Mallory

Abulseoud

Hwang

et al. 2012

Mayo Clinic Proceedings

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Although deep brain stimulation (DBS) has been found to be efficacious for some chronic pain syndromes, its usefulness in patients with central poststroke pain (CPSP) has been disappointing. The most common DBS targets for pain are the periventricular gray region (PVG) and the ventralis caudalis of the thalamus. Despite the limited success of DBS for CPSP, few alternative targets have been explored. The nucleus accumbens (NAC), a limbic structure within the ventral striatum that is involved in reward and pain processing, has emerged as an effective target for psychiatric disease. There is also evidence that it may be an effective target for pain. We describe a 72-year-old woman with a large right hemisphere infarct who subsequently experienced refractory left hemibody pain. She underwent placement of 3 electrodes in the right PVG, ventralis caudalis of the thalamus, and NAC. Individual stimulation of the NAC and PVG provided substantial improvement in pain rating. The patient underwent implantation of permanent electrodes in both targets, and combined stimulation has provided sustained pain relief at nearly 1 year after the procedure. These results suggest that the NAC may be an effective DBS target for CPSP.

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Potential surgical targets for deep brain stimulation in treatment-resistant depression

Cited by 82 publications

References 68 publications

Desynchronization and Plasticity of Striato-frontal Connectivity in Major Depressive Disorder

Desynchronization and Plasticity of Striato-frontal Connectivity in Major Depressive Disorder

The Application of Vagus Nerve Stimulation and Deep Brain Stimulation in Depression

The Nucleus Accumbens as a Potential Target for Central Poststroke Pain

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