The Use of Tractography-Based Targeting in Deep Brain Stimulation for Psychiatric Indications

Davidson, Benjamin; Lipsman, Nir; Meng, Ying; Rabin, Jennifer S.; Giacobbe, Peter; Hamani, Clement

doi:10.3389/fnhum.2020.588423

Cited by 10 publications

(5 citation statements)

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“…The success of a DBS procedure may be more related to the engagement of specific neuronal fibers running through the VC/VS and neuronal circuits than relying on anatomical coordinates (36,39,41). This situation confirms the belief that depression is a disorder of neuronal brain circuits, and effective stimulation depends to the greatest extent on the modulation of fibers connecting the areas of the brain that are responsible for the pathophysiology of depression (40,(42)(43)(44)(45).…”

Section: Limitations Of Current Dbs Studies For Trdmentioning

confidence: 64%

“…DBS is the most invasive treatment for TRD. In most studies, the prerequisite is the confirmation of severity, chronicity, disability, and pharmacological refractoriness in patients diagnosed with TRD (21, [28][29][30][31][32][33][34][35][36][37][38][39][40]. The first step is a correct clinical diagnosis of depression.…”

Section: Inclusion and Exclusion Criteria For Nac/vs And Vc Dbs For Trdmentioning

confidence: 99%

“…In addition, the lack of neurobiological markers of psychiatric disorders coupled with no symptom-specific prediction hinders the selection process. Meeting the inclusion and exclusion criteria and a time-consuming qualification process are responsible for a still small number of TRD patients who undergo DBS procedures worldwide (21,22,(29)(30)(31)(36)(37)(38)(39)(40).…”

Section: Inclusion and Exclusion Criteria For Nac/vs And Vc Dbs For Trdmentioning

confidence: 99%

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The ventral capsule and ventral striatum—Stereotactic targets for the management of treatment-resistant depression. A systematic literature review

Sobstyl,

Prokopienko,

Pietras

2023

Front. Psychiatry

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BackgroundDeep brain stimulation (DBS) is still an experimental treatment modality for psychiatric disorders including treatment-resistant depression (TRD). There is preliminary evidence that stimulation of brain reward circuit structures including the ventral striatum (VS) may exert an antidepressant effect. The main nucleus of the reward circuit is the nucleus accumbens (NAc). The NAc is a major structure of VS that plays a critical role in reward-seeking behavior, motivation, and addiction.AimsThis study aimed to review the current studies including randomized clinical trials, open-label trials, and case reports of NAc/VS and VC DBS for TRD in humans.MethodThe literature was reviewed using a medical database—Medical Literature, Analysis, and Retrieval System Online (MEDLINE) on NAc/VS or VC DBS in TRD. The identified studies were assessed based on the patient's characteristics, clinical outcomes, and adverse events related to DBS as well as the stereotactic technique used to guide the implantation of DBS electrodes. The inclusion and exclusion criteria of DBS for TRD were presented and discussed.ResultsThe searched literature revealed one case report, three open-label studies (OLS), one multicenter open-label study (mOLS), and two randomized clinical trials (RCTs). There were three additional studies reporting the clinical outcomes in the long term in TRD patients included in the two mentioned RCTs. The total number of patients with TRD treated by NAc/VS or VC is estimated to be 85 individuals worldwide. The response rate to DBS defined as a 50% reduction of postoperative Montgomery-Asberg Depression Rating Scale (MADRS) scores was achieved in 39.8% of the operated patients (range, 23–53%). The remission defined as MADRS scores of < 10 was found in 17.8% after DBS (range, 0–40%). The mean follow-up was 19.7 months (range 3.7–24 months).ConclusionThe current results of NAc/VS and VC DBS are still limited by a relatively small number of patients treated worldwide. Nevertheless, the results suggest that NAc/VS and VC can be regarded as promising and efficacious targets for DBS, taking into account the response and remission rates among TRD patients with no other treatment option. The adverse events of NAc/VS and VC DBS are reversible due to the adjustment of stimulation parameters. The most common adverse events were hypomanic/manic states, suicidal thoughts/attempts, and suicides. Patients with TRD after NAc/VS and VC DBS should be strictly followed to prevent or diminish these stimulation-induced adverse events.

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Section: Limitations Of Current Dbs Studies For Trdmentioning

confidence: 64%

Section: Inclusion and Exclusion Criteria For Nac/vs And Vc Dbs For Trdmentioning

confidence: 99%

Section: Inclusion and Exclusion Criteria For Nac/vs And Vc Dbs For Trdmentioning

confidence: 99%

See 1 more Smart Citation

The ventral capsule and ventral striatum—Stereotactic targets for the management of treatment-resistant depression. A systematic literature review

Sobstyl,

Prokopienko,

Pietras

2023

Front. Psychiatry

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“…In our study, all electrodes were implanted in gray matter. An interesting extension of our work would be to evaluate whether state-dependent effects also exist in white matter stimulation paradigms (such as those for treatment-resistant depression) [ 40 , 41 ]. This would have implications for adaptive stimulation paradigms for treatment of neuropsychiatric conditions.…”

Section: Discussionmentioning

confidence: 99%

Evidence of state-dependence in the effectiveness of responsive neurostimulation for seizure modulation

et al. 2021

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Background: An implanted device for brain-responsive neurostimulation (RNS ® System) is approved as an effective treatment to reduce seizures in adults with medically-refractory focal epilepsy. Clinical trials of the RNS System demonstrate population-level reduction in average seizure frequency, but therapeutic response is highly variable. Hypothesis: Recent evidence links seizures to cyclical fluctuations in underlying risk. We tested the hypothesis that effectiveness of responsive neurostimulation varies based on current state within cyclical risk fluctuations. Methods: We analyzed retrospective data from 25 adults with medically-refractory focal epilepsy implanted with the RNS System. Chronic electrocorticography was used to record electrographic seizures, and hidden Markov models decoded seizures into fluctuations in underlying risk. State-dependent associations of RNS System stimulation parameters with changes in risk were estimated. Results: Higher charge density was associated with improved outcomes, both for remaining in a low seizure risk state and for transitioning from a high to a low seizure risk state. The effect of stimulation frequency depended on initial seizure risk state: when starting in a low risk state, higher stimulation frequencies were associated with remaining in a low risk state, but when starting in a high risk state, lower stimulation frequencies were associated with transition to a low risk state. Findings were consistent across bipolar and monopolar stimulation configurations. Conclusion: The impact of RNS on seizure frequency exhibits state-dependence, such that stimulation parameters which are effective in one seizure risk state may not be effective in another. These findings represent conceptual advances in understanding the therapeutic mechanism of RNS, and directly inform current practices of RNS tuning and the development of next-generation neurostimulation systems.

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“…While very high resolution dMRI has been acquired with ex vivo scans in both humans and macaques ( Azadbakht et al, 2015 ; Calabrese et al, 2015 ; Fritz et al, 2019 ; Sébille et al, 2019 ), there are significant benefits to acquiring high resolution scans in vivo. For example, individualized surgical planning for deep brain stimulation (DBS) in humans and macaques can benefit from in vivo dMRI for targeting ( Davidson et al, 2020 ; Hunsche et al, 2013 ; Patriat et al, 2018 ; Plantinga et al, 2018 ; Johnson et al, 2016 ). Similarly, preoperative dMRI scans can guide intracranial electrode implantation in macaques ( Saalmann et al, 2012 ).…”

Section: Introductionmentioning

confidence: 99%

Ultra-high field (10.5T) diffusion-weighted MRI of the macaque brain

et al. 2022

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The Use of Tractography-Based Targeting in Deep Brain Stimulation for Psychiatric Indications

Cited by 10 publications

References 82 publications

The ventral capsule and ventral striatum—Stereotactic targets for the management of treatment-resistant depression. A systematic literature review

The ventral capsule and ventral striatum—Stereotactic targets for the management of treatment-resistant depression. A systematic literature review

Evidence of state-dependence in the effectiveness of responsive neurostimulation for seizure modulation

Ultra-high field (10.5T) diffusion-weighted MRI of the macaque brain

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