Conner Christopher R, Quevedo Joao, Soares Jair C, Fenoy Albert J
Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA.
Center of Excellence on Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), Houston, TX, USA.
Mol Psychiatry. 2022 Nov;27(11):4561-4567. doi: 10.1038/s41380-022-01726-0. Epub 2022 Aug 19.
Deep brain stimulation (DBS) to the superolateral branch of the medial forebrain bundle is an efficacious therapy for treatment-resistant depression, providing rapid antidepressant effects. In this study, we use F-fluorodeoxyglucose-positron emission tomography (PET) to identify brain metabolic changes over 12 months post-DBS implantation in ten of our patients, compared to baseline. The primary outcome measure was a 50% reduction in Montgomery-Åsberg Depression Rating Scale (MADRS) score, which was interpreted as a response. Deterministic fiber tracking was used to individually map the target area; probabilistic tractography was used to identify modulated fiber tracts modeled using the cathodal contacts. Eight of the ten patients included in this study were responders. PET imaging revealed significant decreases in bilateral caudate, mediodorsal thalamus, and dorsal anterior cingulate cortex metabolism that was evident at 6 months and continued to 12 months post surgery. At 12 months post-surgery, significant left ventral prefrontal cortical metabolic decreases were also observed. Right caudate metabolic decrease at 12 months was significantly correlated with mean MADRS reduction. Probabilistic tractography modeling revealed that such metabolic changes lay along cortico-limbic nodes structurally connected to the DBS target site. Such observed metabolic changes following DBS correlated with clinical response provide insights into how future studies can elaborate such data to create biomarkers to predict response, the development of which likely will require multimodal imaging analysis.
对内侧前脑束超外侧分支进行深部脑刺激（DBS）是治疗难治性抑郁症的一种有效疗法，可提供快速抗抑郁效果。在本研究中，我们使用氟脱氧葡萄糖正电子发射断层扫描（PET）来识别10例患者在DBS植入后12个月内相对于基线的脑代谢变化。主要结局指标是蒙哥马利-Åsberg抑郁评定量表（MADRS）评分降低50%，这被视为有反应。使用确定性纤维追踪来单独绘制目标区域；使用概率性纤维束成像来识别使用阴极触点建模的调制纤维束。本研究纳入的10例患者中有8例有反应。PET成像显示双侧尾状核、丘脑背内侧核和背侧前扣带回皮质代谢显著降低，在术后6个月时明显，并持续至术后12个月。术后12个月时，还观察到左侧腹侧前额叶皮质代谢显著降低。术后12个月时右侧尾状核代谢降低与MADRS平均降低显著相关。概率性纤维束成像建模显示，此类代谢变化沿与DBS靶点部位结构相连的皮质-边缘节点分布。DBS后观察到的此类代谢变化与临床反应相关，为未来研究如何详细分析此类数据以创建预测反应的生物标志物提供了见解，而生物标志物的开发可能需要多模态成像分析。
