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

Clinical article

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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Graph showing HRSD-17 scores over time in 21 patients receiving DBS.

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    Upper: Bar graph demonstrating CGI-S scores at baseline and after SCG DBS in 21 patients. The colors represent the categories from 1 to 7 on the CGI-S Scale. The vertical axis is the number of patients at each time point. At baseline, the majority of patients were extremely ill and among the most ill patients (Categories 6 and 7). With time, patients improved, shifting to markedly ill (Categories 4 and 5), mildly ill (Categories 2 and 3), and in some cases normal (Category 1). The CGI-S scores at baseline were available for less than the entire sample of 21 patients. Lower: Number of patients who improved (a, Categories 1–3), showed no change (b, Category 4), or worsened (c, Categories 5–7) after SCG DBS, as assessed using the CGI-S improvement scores at 3, 6, 9, or 12 months. With time after DBS, most patients improved. Data were not available for the entire sample of 21 patients. (CGI scale: Considering your total clinical experience with this particular population, how mentally ill is the patient at this time? 0 = not assessed; 1 = normal, not at all ill; 2 = borderline mentally ill; 3 = mildly ill; 4 = moderately ill; 5 = markedly ill; 6 = severely ill; 7 = among the most extremely ill patients.)

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    Mean location of active stimulation contact projected onto the SCG in patients undergoing SCG DBS. The figure is a schematic representation of the average location of the active contacts at 6 months across the 3 centers. The horizontal scale normalizes the distance between the anterior commissure and the anterior border of the corpus callosum. The vertical scale is the normalized distance between the base of the brain and the inferior-most point of the corpus callosum. No differences were found across centers in the anteroposterior, dorsoventral, and mediolateral axes (the latter not shown). Central dots represent the mean location of contacts and the lines SDs. Modified and reprinted from Schaltenbrand G, Wahren W: Atlas for Stereotaxy of the Human Brain. Stuttgart: Georg Thieme Verlag, 1977. Used with permission from Thieme.

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