Mayberg Helen S, Lozano Andres M, Voon Valerie, McNeely Heather E, Seminowicz David, Hamani Clement, Schwalb Jason M, Kennedy Sidney H
Rotman Research Institute at Baycrest Centre, and Departments of Psychiatry and Neurology, University of Toronto, Toronto, Ontario, M6A 2E1, Canada.
Neuron. 2005 Mar 3;45(5):651-60. doi: 10.1016/j.neuron.2005.02.014.
Treatment-resistant depression is a severely disabling disorder with no proven treatment options once multiple medications, psychotherapy, and electroconvulsive therapy have failed. Based on our preliminary observation that the subgenual cingulate region (Brodmann area 25) is metabolically overactive in treatment-resistant depression, we studied whether the application of chronic deep brain stimulation to modulate BA25 could reduce this elevated activity and produce clinical benefit in six patients with refractory depression. Chronic stimulation of white matter tracts adjacent to the subgenual cingulate gyrus was associated with a striking and sustained remission of depression in four of six patients. Antidepressant effects were associated with a marked reduction in local cerebral blood flow as well as changes in downstream limbic and cortical sites, measured using positron emission tomography. These results suggest that disrupting focal pathological activity in limbic-cortical circuits using electrical stimulation of the subgenual cingulate white matter can effectively reverse symptoms in otherwise treatment-resistant depression.
难治性抑郁症是一种严重致残的疾病，一旦多种药物治疗、心理治疗和电休克治疗均告失败，就没有已证实有效的治疗选择。基于我们的初步观察，即膝下扣带区域（布罗德曼25区）在难治性抑郁症中代谢过度活跃，我们研究了对六名难治性抑郁症患者应用慢性脑深部刺激来调节25区是否能降低这种过度活跃并产生临床益处。对膝下扣带回附近白质束的慢性刺激与六名患者中的四名患者显著且持续的抑郁缓解相关。使用正电子发射断层扫描测量，抗抑郁作用与局部脑血流量的显著减少以及下游边缘和皮质部位的变化有关。这些结果表明，通过对膝下扣带白质进行电刺激来破坏边缘-皮质回路中的局灶性病理活动，可以有效逆转难治性抑郁症的症状。
