Rapid Effects of Deep Brain Stimulation for Treatment-Resistant Major Depression

Schläepfer, Thomas E.; Bewernick, Bettina H.; Kayser, Sarah; Mädler, Burkhard; Coenen, Volker A.

doi:10.1016/j.biopsych.2013.01.034

Cited by 499 publications

(459 citation statements)

References 33 publications

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“…This target was already found to determine a rapid clinical improvement [11], as observed in our patient, who also showed a sustained remission at 12 months. In fact, a remarkable reduction of depressive symptoms was achieved within 3 months from device activation.…”

Section: Discussionsupporting

confidence: 73%

“…The day before surgery, a 1.5 Tesla brain MRI-scan was performed acquiring a T2 FSE sequence, a 1 mm slice contrast-enhancement T1 sequence, and a DTI sequence (used to detect the MFB spanning from the ventral tegmental area through the nucleus accumbens to the prefrontal cortex) [11]. The day of surgical implant, a stereotactic CT scan was performed.…”

Section: (Scoring 3/4 At the Related Hdrs-21 Item)mentioning

confidence: 99%

“…Such structures play a crucial role in regulating the reward pathways and have been reportedly indicated as effective DBS targets in patients with TRD [11][12][13]. Few follow-up studies exist on the DBS-implanted patients, particularly with respect to the MFB target.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Deep Brain Stimulation of the Medial Forebrain Bundle in a Patient with Treatment-Resistant Bipolar Depression and Comorbid OCD: Acute and 12-Month Follow-Up Results

Oldani¹,

Porta²,

Servello³

et al. 2017

Neuropsychiatry

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Limited but encouraging evidence exists on the efficacy of Deep Brain Stimulation (DBS) of the Medial Forebrain Bundle (MBF) in otherwise intractable patients with Major Depressive and Obsessive-Compulsive Disorder (OCD). Subject and Methods: Herein, we present acute and follow-up results (up to 12-months) of the first Italian patient, a 34 year old man with a diagnosis of treatment-resistant Bipolar Depression (BD) and comorbid OCD, successfully treated with DBS of the MFB. Periodic follow-up visits with psychometric evaluations highlighted a remarkable improvement of patient's depressive and OC symptoms at 3 months (50-80% scores reduction), that was maintained at 6 and 12 months. In particular, suicidal ideation, which was found to be pervasive before the implant as well as patient's overall disability, showed a rapid and significant acute response to DBS. Over the 12 months of stimulation, pre-implant pharmacological treatment could be gradually decreased, while the patient remained clinically stable. According to the limited, reported experience, we support the efficacy and tolerability of DBS of the MFB as a promising intervention in patients with treatment-resistant BD and comorbid OCD, particularly in relation to acute and post-acute outcome. Larger controlled trials are needed to confirm our findings and assess DBS therapeutic properties in the long-term.

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Section: Discussionsupporting

confidence: 73%

Section: (Scoring 3/4 At the Related Hdrs-21 Item)mentioning

confidence: 99%

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Deep Brain Stimulation of the Medial Forebrain Bundle in a Patient with Treatment-Resistant Bipolar Depression and Comorbid OCD: Acute and 12-Month Follow-Up Results

Oldani¹,

Porta²,

Servello³

et al. 2017

Neuropsychiatry

View full text Add to dashboard Cite

show abstract

“…First, the patient populations treated with invasive or noninvasive brain stimulation are starting to converge. For example, the primary indication for TMS is depression, and the primary indication for DBS is Parkinson's disease, but DBS is being investigated as a treatment for depression, and TMS is being investigated as a treatment for Parkinson's disease (4,(20)(21)(22)(23)(24)(25). Second, although therapeutic mechanisms remain unknown, invasive and noninvasive brain stimulation share important properties.…”

Section: Significancementioning

confidence: 99%

Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases

Fox

Buckner

Liu

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

514

445

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Significance Brain stimulation is a powerful treatment for an increasing number of psychiatric and neurological diseases, but it is unclear why certain stimulation sites work or where in the brain is the best place to stimulate to treat a given patient or disease. We found that although different types of brain stimulation are applied in different locations, targets used to treat the same disease most often are nodes in the same brain network. These results suggest that brain networks might be used to understand why brain stimulation works and to improve therapy by identifying the best places to stimulate the brain.

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“…A recent pilot study also assessed the safety and efficacy of DBS to the supero-lateral branch of the medial forebrain bundle in seven patients with highly refractory depression (Schlaepfer et al, 2013) with promising results. The choice of these targets is based on various sources of evidence pointing to their involvement in depressive symptoms including functional neuroimaging studies (Kennedy et al, 2007;Lakhan and Callaway, 2010;Mayberg et al, 1999), observations of reduced depressive symptoms following ablative procedures performed on MDD and obsessive compulsive disorder patients (Greenberg et al, 2003) and lesion studies in animal models (Yang et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

EEG Power Asymmetry and Functional Connectivity as a Marker of Treatment Effectiveness in DBS Surgery for Depression

Quraan

Protzner

Daskalakis

et al. 2013

Neuropsychopharmacol

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Recently, deep brain stimulation (DBS) has been evaluated as an experimental therapy for treatment-resistant depression. Although there have been encouraging results in open-label trials, about half of the patients fail to achieve meaningful benefit. Although progress has been made in understanding the neurobiology of MDD, the ability to characterize differences in brain dynamics between those who do and do not benefit from DBS is lacking. In this study, we investigated EEG resting-state data recorded from 12 patients that have undergone DBS surgery. Of those, six patients were classified as responders to DBS, defined as an improvement of 50% or more on the 17-item Hamilton Rating Scale for Depression (HAMD-17). We compared hemispheric frontal theta and parietal alpha power asymmetry and synchronization asymmetry between responders and non-responders. Hemispheric power asymmetry showed statistically significant differences between responders and non-responders with healthy controls showing an asymmetry similar to responders but opposite to non-responders. This asymmetry was characterized by an increase in frontal theta in the right hemisphere relative to the left combined with an increase in parietal alpha in the left hemisphere relative to the right in non-responders compared with responders. Hemispheric mean synchronization asymmetry showed a statistically significant difference between responders and non-responders in the theta band, with healthy controls showing an asymmetry similar to responders but opposite to non-responders. This asymmetry resulted from an increase in frontal synchronization in the right hemisphere relative to the left combined with an increase in parietal synchronization in the left hemisphere relative to the right in non-responders compared with responders. Connectivity diagrams revealed long-range differences in frontal/central-parietal connectivity between the two groups in the theta band. This pattern was observed irrespective of whether EEG data were collected with active DBS or with the DBS stimulation turned off, suggesting stable functional and possibly structural modifications that may be attributed to plasticity.

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Rapid Effects of Deep Brain Stimulation for Treatment-Resistant Major Depression

Cited by 499 publications

References 33 publications

Deep Brain Stimulation of the Medial Forebrain Bundle in a Patient with Treatment-Resistant Bipolar Depression and Comorbid OCD: Acute and 12-Month Follow-Up Results

Deep Brain Stimulation of the Medial Forebrain Bundle in a Patient with Treatment-Resistant Bipolar Depression and Comorbid OCD: Acute and 12-Month Follow-Up Results

Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases

EEG Power Asymmetry and Functional Connectivity as a Marker of Treatment Effectiveness in DBS Surgery for Depression

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