A multicenter pilot study of subcallosal cingulate area deep brain stimulation for treatment-resistant depression

Clinical article

Andres M. Lozano M.D., Ph.D., F.R.C.S.C. 1 , Peter Giacobbe M.D., M.Sc., F.R.C.P.C. 2 , 8 , Clement Hamani M.D., Ph.D. 1 , Sakina J. Rizvi H.B.Sc. 8 , Sidney H. Kennedy M.D., F.R.C.P.C. 2 , 8 , Theodore T. Kolivakis M.D., C.M., F.R.C.P.C. 4 , Guy Debonnel M.D., C.S.P.Q., A.I.H.P. 4 , Abbas F. Sadikot M.D., Ph.D., F.R.C.S.C. 6 , Raymond W. Lam M.D., F.R.C.P.C. 3 , Andrew K. Howard M.D., F.R.C.P.C. 6 , Magda Ilcewicz-Klimek M.D., F.R.C.P.C. 6 , Christopher R. Honey M.D., D.Phil. 5 and Helen S. Mayberg M.D., F.R.C.P.C. 7
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  • 1 Division of Neurosurgery and
  • 2 Department of Psychiatry, University of Toronto;
  • 3 Departments of Neurology and Neurosurgery and
  • 4 Psychiatry, McGill University, Montreal;
  • 5 Division of Surgery (Neurosurgery) and
  • 6 Department of Psychiatry, University of British Columbia, Vancouver, Canada;
  • 7 Department of Psychiatry, Emory University, Atlanta, Georgia; and
  • 8 Department of Psychiatry, University Health Network, University of Toronto, Canada
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Object

Deep brain stimulation (DBS) has been recently investigated as a treatment for major depression. One of the proposed targets for this application is the subcallosal cingulate gyrus (SCG). To date, promising results after SCG DBS have been reported by a single center. In the present study the authors investigated whether these findings may be replicated at different institutions. They conducted a 3-center prospective open-label trial of SCG DBS for 12 months in patients with treatment-resistant depression.

Methods

Twenty-one patients underwent implantation of bilateral SCG electrodes. The authors examined the reduction in Hamilton Rating Scale for Depression (HRSD-17) score from baseline (RESP50).

Results

Patients treated with SCG DBS had an RESP50 of 57% at 1 month, 48% at 6 months, and 29% at 12 months. The response rate after 12 months of DBS, however, increased to 62% when defined as a reduction in the baseline HRSD-17 of 40% or more. Reductions in depressive symptomatology were associated with amelioration in disease severity in patients who responded to surgery.

Conclusions

Overall, findings from this study corroborate the results of previous reports showing that outcome of SCG DBS may be replicated across centers.

Abbreviations used in this paper: CGI-S = Clinical Global Impression–Severity; DBS = deep brain stimulation; HRSD-17 = 17-item Hamilton Rating Scale for Depression; RESP50 = a minimum 50% reduction in the HRSD-17 score from baseline; SCG = subcallosal cingulate gyrus; TRD = treatment-resistant depression.

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Contributor Notes

Address correspondence to: Andres M. Lozano, M.D., Ph.D., Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst Street, WW 4-447, Toronto, Ontario M5T 2S8, Canada. email: lozano@uhnresearch.ca.

Please include this information when citing this paper: published online November 18, 2011; DOI: 10.3171/2011.10.JNS102122.

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