In this study, the authors performed deep brain stimulation (DBS) of the subgenual anterior cingulate cortex (SACC) in a patient with a history of bipolar disorder. After a right thalamic stroke, intractable depression without mood elevation or a mixed state developed in this patient. He underwent bilateral SACC DBS and died 16 months afterwards. Anatomical connections were studied in this patient preoperatively and postmortem using diffusion tractography (DT). A comparison of in vivo and high resolution ex vivo connectivity patterns was performed as a measure of the utility of in vivo DT in presurgical planning for DBS. Diagnostic measures included neuropsychological testing, preoperative and ex vivo DT, and macroscopic neuropathological assessment. Post-DBS depression rating scores did not improve. In vivo and ex vivo DT revealed markedly reduced limbic projections from the thalamus and SACC to the amygdala in the right (stroke-affected) hemisphere. A highly selective right mediothalamic lesion was associated with the onset of refractory depression. Reduced amygdalar-thalamic and amygdalar-SACC connections could be a contraindication to DBS for depression. Correspondence between preoperative and higher resolution ex vivo DT supports the validity of DT as a presurgical planning tool for DBS.
Abbreviations used in this paper:DBS = deep brain stimulation; DT = diffusion tractography; SACC = subgenual anterior cingulate cortex.
Address correspondence to: Jennifer A. McNab, M.Sc., Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom. email:firstname.lastname@example.org.
Please include this information when citing this paper: published online March 13, 2009; DOI: 10.3171/2009.2.JNS081299.
Johansen-BergHGutmanDABehrensTEJMatthewsPMRushworthMFSKatzE: Anatomical connectivity of the subgenual cingulate region targeted with deep brain stimulation for treatment-resistant depression. Cereb Cortex18:1374–13832008
Johansen-BergH, GutmanDA, BehrensTEJ, MatthewsPM, RushworthMFS, KatzE, : Anatomical connectivity of the subgenual cingulate region targeted with deep brain stimulation for treatment-resistant depression. 18:1374–1383, 2008)| false
JuckelGHegerlUMavrogiorgouPGallinatJMagerTTiggesP: Clinical and biological findings in a case with 48-hour bipolar ultrarapid cycling before and during valproate treatment. J Clin Psychiatry61:585–5932000
JuckelG, HegerlU, MavrogiorgouP, GallinatJ, MagerT, TiggesP, : Clinical and biological findings in a case with 48-hour bipolar ultrarapid cycling before and during valproate treatment. 61:585–593, 2000)| false
MaybergHSBrannanSKTekellJLSilvaJAMahurinRKMcGinnisS: Regional metabolic effects of fluoxetine in major depression: serial changes and relationship to clinical response. Biol Psychiatry48:830–8432000
MaybergHS, BrannanSK, TekellJL, SilvaJA, MahurinRK, McGinnisS, : Regional metabolic effects of fluoxetine in major depression: serial changes and relationship to clinical response. 48:830–843, 2000)| false
MaybergHSLiottiMBrannanSKMcGinnisSMahurinRKJerabekPA: Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatry156:675–6821999
MaybergHS, LiottiM, BrannanSK, McGinnisS, MahurinRK, JerabekPA, : Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. 156:675–682, 1999)| false