Cerebral metabolic correlates as potential predictors of response to anterior cingulotomy for treatment of major depression

Darin D. Dougherty Departments of Psychiatry, Radiology, Neurosurgery, and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurology, McLean Hospital, Belmont, Massachusetts; and Departments of Psychiatry and Neurology, Rotman Research Institute, University of Toronto, Ontario, Canada

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Anthony P. Weiss Departments of Psychiatry, Radiology, Neurosurgery, and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurology, McLean Hospital, Belmont, Massachusetts; and Departments of Psychiatry and Neurology, Rotman Research Institute, University of Toronto, Ontario, Canada

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G. Rees Cosgrove Departments of Psychiatry, Radiology, Neurosurgery, and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurology, McLean Hospital, Belmont, Massachusetts; and Departments of Psychiatry and Neurology, Rotman Research Institute, University of Toronto, Ontario, Canada

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Nathaniel M. Alpert Departments of Psychiatry, Radiology, Neurosurgery, and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurology, McLean Hospital, Belmont, Massachusetts; and Departments of Psychiatry and Neurology, Rotman Research Institute, University of Toronto, Ontario, Canada

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Edwin H. Cassem Departments of Psychiatry, Radiology, Neurosurgery, and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurology, McLean Hospital, Belmont, Massachusetts; and Departments of Psychiatry and Neurology, Rotman Research Institute, University of Toronto, Ontario, Canada

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Andrew A. Nierenberg Departments of Psychiatry, Radiology, Neurosurgery, and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurology, McLean Hospital, Belmont, Massachusetts; and Departments of Psychiatry and Neurology, Rotman Research Institute, University of Toronto, Ontario, Canada

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Bruce H. Price Departments of Psychiatry, Radiology, Neurosurgery, and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurology, McLean Hospital, Belmont, Massachusetts; and Departments of Psychiatry and Neurology, Rotman Research Institute, University of Toronto, Ontario, Canada

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Helen S. Mayberg Departments of Psychiatry, Radiology, Neurosurgery, and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurology, McLean Hospital, Belmont, Massachusetts; and Departments of Psychiatry and Neurology, Rotman Research Institute, University of Toronto, Ontario, Canada

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Alan J. Fischman Departments of Psychiatry, Radiology, Neurosurgery, and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurology, McLean Hospital, Belmont, Massachusetts; and Departments of Psychiatry and Neurology, Rotman Research Institute, University of Toronto, Ontario, Canada

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Scott L. Rauch Departments of Psychiatry, Radiology, Neurosurgery, and Neurology, Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurology, McLean Hospital, Belmont, Massachusetts; and Departments of Psychiatry and Neurology, Rotman Research Institute, University of Toronto, Ontario, Canada

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Object. Neurosurgical procedures are a viable intervention for severe, treatment-refractory major depression, although they have been associated with only modest rates of efficacy. The purpose of this study was to identify possible neuroimaging predictors of treatment response to anterior cingulotomy in patients with major depression.

Methods. Thirteen patients underwent stereotactic anterior cingulotomy for treatment-refractory major depression. Symptom severity was measured using the Beck Depression Inventory (BDI) both before and approximately 12 months after surgery. The authors performed [18F]fluorodeoxyglucose—positron emission tomography (PET) studies in all patients preoperatively. Statistical parametric mapping methods were used to test for loci of significant correlation between preoperative regional cerebral metabolism and postoperative reduction in BDI scores.

The mean (± standard deviation) change in the BDI score from the preoperative period (43.7 ± 7.8) to the postoperative period (30.5 ± 21.3) was 33.1 ± 45.4%. Two loci—the left subgenual prefrontal cortex and left thalamus—were identified as sites at which preoperative metabolism was significantly correlated with subsequent improvement in depressive symptom severity following cingulotomy. Specifically, higher preoperative rates of metabolism at these loci were associated with better postoperative results.

Conclusions. Possible PET scanning predictors of treatment response were identified in patients with major depression who had undergone anterior cingulotomy. Further research will be necessary to determine the reproducibility of this finding. If confirmed, the availability of an index for noninvasively predicting a patient's response to cingulotomy for the treatment of major depression would be of great clinical value.

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