Deep brain stimulation of the medial forebrain bundle: Distinctive responses in resistant depression
| Autor: | Jair C. Soares, Bo Cao, Prashant Gajwani, Paul E. Schulz, Danielle Spiker, João Quevedo, Christina L. Burrows, Giovanna Zunta-Soares, Albert J. Fenoy, Sudhakar Selvaraj |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Deep brain stimulation Deep Brain Stimulation medicine.medical_treatment Neuroimaging Pilot Projects Stimulation Depressive Disorder Treatment-Resistant 03 medical and health sciences 0302 clinical medicine medicine Humans Medial forebrain bundle Depression (differential diagnoses) Motivation Medial Forebrain Bundle Anhedonia Middle Aged medicine.disease Interim analysis 030227 psychiatry Surgery Affect Psychiatry and Mental health Clinical Psychology Diffusion Tensor Imaging Treatment Outcome Mood Anesthesia Female medicine.symptom Psychology Treatment-resistant depression 030217 neurology & neurosurgery |
| Zdroj: | Journal of Affective Disorders. 203:143-151 |
| ISSN: | 0165-0327 |
| DOI: | 10.1016/j.jad.2016.05.064 |
| Popis: | Background Treatment resistant depression (TRD) is a serious, disabling disease. Deep brain stimulation (DBS) to the superolateral branch of the medial forebrain bundle (MFB), as proposed by Schlaepfer et al. (2013), has led to rapid anti-depressant response but has not been replicated. Methods In this interim analysis of an ongoing pilot study of ten subjects, we assessed the efficacy of MFB-DBS in a cohort of four TRD patients over a 52-week period using the Montgomery-Asberg Depression Rating Scale (MADRS) as the primary assessment tool. Implanted patients entered a 4-week single-blinded sham stimulation period prior to stimulation initiation. Deterministic fiber tracking analysis was performed to compare modulated fiber tracts between patients. Results Intraoperatively, responder patients displayed immediate increased signs of energy and motivation upon stimulation at target. There was no significant mean change in mood during sham stimulation phase. Three of 4 patients had >50% decrease in MADRS scores at 7 days post-stimulation initiation relative to baseline. One patient withdrew from study participation. At 26 weeks, two of 3 remaining patients continue to have >80% decrease in MADRS scores. One patient failed to have response; evaluation of modulated fiber tracts revealed reduced frontal connectivity to the target region. Limitations This is an interim report, with limited conclusions. Conclusion This study of MFB-DBS shows similar rapid anti-depressant effects within the first week of stimulation as initially reported by Schlaepfer et al. (2013). Implementation of anhedonia measurements would greatly augment characterization of the striking motivational effects observed. We urge others to pursue this target to further prove efficacy. ClinicalTrials.gov (identifier: NCT02046330) https://clinicaltrials.gov/ct2/show/NCT02046330 |
| Databáze: | OpenAIRE |
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