Neuroanatomical predictors of response to subcallosal cingulate deep brain stimulation for treatment-resistant depression
Deep brain stimulation targeting the subcallosal cingulate gyrus (SCG DBS) improves the symptoms of treatment-resistant depression in some patients, but not in others. We hypothesized that there are pre-existing structural brain differences between responders and nonresponders to SCG DBS, detectable...
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| Veröffentlicht in: | Journal of psychiatry & neuroscience 2020-01, Vol.45 (1), p.45-54 |
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| creator | Sankar, Tejas Chakravarty, M. Mallar Jawa, Natasha Li, Stanley X. Giacobbe, Peter Kennedy, Sidney H. Rizvi, Sakina J. Mayberg, Helen S. Hamani, Clement Lozano, Andres M. |
| description | Deep brain stimulation targeting the subcallosal cingulate gyrus (SCG DBS) improves the symptoms of treatment-resistant depression in some patients, but not in others. We hypothesized that there are pre-existing structural brain differences between responders and nonresponders to SCG DBS, detectable using structural MRI.
We studied preoperative, T1-weighted MRI scans of 27 patients treated with SCG DBS from 2003 to 2011. Responders (n = 15) were patients with a >50% improvement in Hamilton Rating Scale for Depression score following 12 months of SCG DBS. Preoperative subcallosal cingulate gyrus grey matter volume was obtained using manual segmentation by a trained observer blinded to patient identity. Volumes of hippocampus, thalamus, amygdala, whole-brain cortical grey matter and white matter volume were obtained using automated techniques.
Preoperative subcallosal cingulate gyrus, thalamic and amygdalar volumes were significantly larger in patients who went on to respond to SCG-DBS. Hippocampal volume did not differ between groups. Cortical grey matter volume was significantly smaller in responders, and cortical grey matter:white matter ratio distinguished between responders and nonresponders with high sensitivity and specificity.
Normalization by intracranial volume nullified some between-group differences in volumetric measures.
There are structural brain differences between patients with treatment-resistant depression who respond to SCG DBS and those who do not. Specifically, the structural integrity of the subcallosal cingulate gyrus target region and its connected subcortical areas, and variations in cortical volume across the entire brain, appear to be important determinants of response. Structural MRI shows promise as a biomarker in deep brain stimulation for depression, and may play a role in refining patient selection for future trials. |
| doi_str_mv | 10.1503/jpn.180207 |
| format | Article |
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We studied preoperative, T1-weighted MRI scans of 27 patients treated with SCG DBS from 2003 to 2011. Responders (n = 15) were patients with a >50% improvement in Hamilton Rating Scale for Depression score following 12 months of SCG DBS. Preoperative subcallosal cingulate gyrus grey matter volume was obtained using manual segmentation by a trained observer blinded to patient identity. Volumes of hippocampus, thalamus, amygdala, whole-brain cortical grey matter and white matter volume were obtained using automated techniques.
Preoperative subcallosal cingulate gyrus, thalamic and amygdalar volumes were significantly larger in patients who went on to respond to SCG-DBS. Hippocampal volume did not differ between groups. Cortical grey matter volume was significantly smaller in responders, and cortical grey matter:white matter ratio distinguished between responders and nonresponders with high sensitivity and specificity.
Normalization by intracranial volume nullified some between-group differences in volumetric measures.
There are structural brain differences between patients with treatment-resistant depression who respond to SCG DBS and those who do not. Specifically, the structural integrity of the subcallosal cingulate gyrus target region and its connected subcortical areas, and variations in cortical volume across the entire brain, appear to be important determinants of response. Structural MRI shows promise as a biomarker in deep brain stimulation for depression, and may play a role in refining patient selection for future trials.</description><identifier>ISSN: 1180-4882</identifier><identifier>EISSN: 1488-2434</identifier><identifier>DOI: 10.1503/jpn.180207</identifier><identifier>PMID: 31525860</identifier><language>eng</language><publisher>Canada: Joule Inc</publisher><subject>Adult ; Amygdala ; Amygdala - diagnostic imaging ; Amygdala - pathology ; Anatomy ; Biomarkers ; Brain ; Brain architecture ; Brain research ; Cerebral cortex ; Clinical trials ; Deep Brain Stimulation ; Depression (Mood disorder) ; Depressive Disorder, Treatment-Resistant - diagnostic imaging ; Depressive Disorder, Treatment-Resistant - pathology ; Depressive Disorder, Treatment-Resistant - therapy ; Drug therapy ; Female ; Gray Matter - diagnostic imaging ; Gray Matter - pathology ; Gyrus Cinguli - diagnostic imaging ; Gyrus Cinguli - pathology ; Hippocampus ; Hippocampus - diagnostic imaging ; Hippocampus - pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Medical equipment industry ; Mental depression ; Middle Aged ; Neurophysiology ; Outcome Assessment, Health Care ; Patients ; Research Paper ; Retrospective Studies ; Segmentation ; Statistical analysis ; Studies ; Substantia alba ; Substantia grisea ; Thalamus ; Thalamus - diagnostic imaging ; Thalamus - pathology ; Volumetric analysis ; White Matter - diagnostic imaging ; White Matter - pathology</subject><ispartof>Journal of psychiatry & neuroscience, 2020-01, Vol.45 (1), p.45-54</ispartof><rights>2020 Joule Inc. or its licensors</rights><rights>COPYRIGHT 2020 Joule Inc.</rights><rights>2020. This work is published under NOCC (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Joule Inc. or its licensors 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c637t-a5b3a388afd2cc87f5ad87e3b68532d636e083ca75e79bc820fee483ecb65f083</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919920/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6919920/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31525860$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sankar, Tejas</creatorcontrib><creatorcontrib>Chakravarty, M. Mallar</creatorcontrib><creatorcontrib>Jawa, Natasha</creatorcontrib><creatorcontrib>Li, Stanley X.</creatorcontrib><creatorcontrib>Giacobbe, Peter</creatorcontrib><creatorcontrib>Kennedy, Sidney H.</creatorcontrib><creatorcontrib>Rizvi, Sakina J.</creatorcontrib><creatorcontrib>Mayberg, Helen S.</creatorcontrib><creatorcontrib>Hamani, Clement</creatorcontrib><creatorcontrib>Lozano, Andres M.</creatorcontrib><title>Neuroanatomical predictors of response to subcallosal cingulate deep brain stimulation for treatment-resistant depression</title><title>Journal of psychiatry & neuroscience</title><addtitle>J Psychiatry Neurosci</addtitle><description>Deep brain stimulation targeting the subcallosal cingulate gyrus (SCG DBS) improves the symptoms of treatment-resistant depression in some patients, but not in others. We hypothesized that there are pre-existing structural brain differences between responders and nonresponders to SCG DBS, detectable using structural MRI.
We studied preoperative, T1-weighted MRI scans of 27 patients treated with SCG DBS from 2003 to 2011. Responders (n = 15) were patients with a >50% improvement in Hamilton Rating Scale for Depression score following 12 months of SCG DBS. Preoperative subcallosal cingulate gyrus grey matter volume was obtained using manual segmentation by a trained observer blinded to patient identity. Volumes of hippocampus, thalamus, amygdala, whole-brain cortical grey matter and white matter volume were obtained using automated techniques.
Preoperative subcallosal cingulate gyrus, thalamic and amygdalar volumes were significantly larger in patients who went on to respond to SCG-DBS. Hippocampal volume did not differ between groups. Cortical grey matter volume was significantly smaller in responders, and cortical grey matter:white matter ratio distinguished between responders and nonresponders with high sensitivity and specificity.
Normalization by intracranial volume nullified some between-group differences in volumetric measures.
There are structural brain differences between patients with treatment-resistant depression who respond to SCG DBS and those who do not. Specifically, the structural integrity of the subcallosal cingulate gyrus target region and its connected subcortical areas, and variations in cortical volume across the entire brain, appear to be important determinants of response. Structural MRI shows promise as a biomarker in deep brain stimulation for depression, and may play a role in refining patient selection for future trials.</description><subject>Adult</subject><subject>Amygdala</subject><subject>Amygdala - diagnostic imaging</subject><subject>Amygdala - pathology</subject><subject>Anatomy</subject><subject>Biomarkers</subject><subject>Brain</subject><subject>Brain architecture</subject><subject>Brain research</subject><subject>Cerebral cortex</subject><subject>Clinical trials</subject><subject>Deep Brain Stimulation</subject><subject>Depression (Mood disorder)</subject><subject>Depressive Disorder, Treatment-Resistant - diagnostic imaging</subject><subject>Depressive Disorder, Treatment-Resistant - pathology</subject><subject>Depressive Disorder, Treatment-Resistant - therapy</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Gray Matter - diagnostic imaging</subject><subject>Gray Matter - pathology</subject><subject>Gyrus Cinguli - diagnostic imaging</subject><subject>Gyrus Cinguli - pathology</subject><subject>Hippocampus</subject><subject>Hippocampus - diagnostic imaging</subject><subject>Hippocampus - pathology</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical equipment industry</subject><subject>Mental depression</subject><subject>Middle Aged</subject><subject>Neurophysiology</subject><subject>Outcome Assessment, Health Care</subject><subject>Patients</subject><subject>Research Paper</subject><subject>Retrospective Studies</subject><subject>Segmentation</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Substantia alba</subject><subject>Substantia grisea</subject><subject>Thalamus</subject><subject>Thalamus - diagnostic imaging</subject><subject>Thalamus - pathology</subject><subject>Volumetric analysis</subject><subject>White Matter - diagnostic imaging</subject><subject>White Matter - pathology</subject><issn>1180-4882</issn><issn>1488-2434</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqV0luL1DAUB_AiiruOvvgBpLggKnTMZdqmL8KyeFlYVvDyHNL0tJOhTbpJKu6395RZ16nMi_Sh7ckv_6TNSZLnlKxpTvi73WjXVBBGygfJKd0IkbEN3zzEZ6xm-M5Okich7AhBQ_PHyQmnOctFQU6T22uYvFNWRTcYrfp09NAYHZ0PqWtTD2F0NkAaXRqmGkHvAiptbDf1KkLaAIxp7ZWxaYhmmIvG2bR1Po0eVBzAxgxjTIjKRuS4QAhIniaPWtUHeHZ3XyU_Pn74fvE5u_ry6fLi_CrTBS9jpvKaKy6EahumtSjbXDWiBF4XIuesKXgBRHCtyhzKqtaCkRZgIzjoushbHFol7_e541QP0Gjcj1e9HL0ZlL-VThm5HLFmKzv3UxYVrSpGMOD1XYB3NxOEKAcTNPS9suCmIBmrWCWYwJ--Ss7-oTs3eYufJxnnBSekIOVf1akepLGtw3X1HCrPC0r4htJyVtkR1YEF3KSz0BosL_zLI16P5kYeovURhFcDePxHU98sJqCJ8Ct2agpBXn77-h_2emlfHdgtqD5ug-unuXnCEr7dQ-1dCB7a-5OjRM7tL7H95b79Eb84POt7-qff-W-3j_6z</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Sankar, Tejas</creator><creator>Chakravarty, M. 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Mallar</au><au>Jawa, Natasha</au><au>Li, Stanley X.</au><au>Giacobbe, Peter</au><au>Kennedy, Sidney H.</au><au>Rizvi, Sakina J.</au><au>Mayberg, Helen S.</au><au>Hamani, Clement</au><au>Lozano, Andres M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neuroanatomical predictors of response to subcallosal cingulate deep brain stimulation for treatment-resistant depression</atitle><jtitle>Journal of psychiatry & neuroscience</jtitle><addtitle>J Psychiatry Neurosci</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>45</volume><issue>1</issue><spage>45</spage><epage>54</epage><pages>45-54</pages><issn>1180-4882</issn><eissn>1488-2434</eissn><abstract>Deep brain stimulation targeting the subcallosal cingulate gyrus (SCG DBS) improves the symptoms of treatment-resistant depression in some patients, but not in others. We hypothesized that there are pre-existing structural brain differences between responders and nonresponders to SCG DBS, detectable using structural MRI.
We studied preoperative, T1-weighted MRI scans of 27 patients treated with SCG DBS from 2003 to 2011. Responders (n = 15) were patients with a >50% improvement in Hamilton Rating Scale for Depression score following 12 months of SCG DBS. Preoperative subcallosal cingulate gyrus grey matter volume was obtained using manual segmentation by a trained observer blinded to patient identity. Volumes of hippocampus, thalamus, amygdala, whole-brain cortical grey matter and white matter volume were obtained using automated techniques.
Preoperative subcallosal cingulate gyrus, thalamic and amygdalar volumes were significantly larger in patients who went on to respond to SCG-DBS. Hippocampal volume did not differ between groups. Cortical grey matter volume was significantly smaller in responders, and cortical grey matter:white matter ratio distinguished between responders and nonresponders with high sensitivity and specificity.
Normalization by intracranial volume nullified some between-group differences in volumetric measures.
There are structural brain differences between patients with treatment-resistant depression who respond to SCG DBS and those who do not. Specifically, the structural integrity of the subcallosal cingulate gyrus target region and its connected subcortical areas, and variations in cortical volume across the entire brain, appear to be important determinants of response. Structural MRI shows promise as a biomarker in deep brain stimulation for depression, and may play a role in refining patient selection for future trials.</abstract><cop>Canada</cop><pub>Joule Inc</pub><pmid>31525860</pmid><doi>10.1503/jpn.180207</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Amygdala Amygdala - diagnostic imaging Amygdala - pathology Anatomy Biomarkers Brain Brain architecture Brain research Cerebral cortex Clinical trials Deep Brain Stimulation Depression (Mood disorder) Depressive Disorder, Treatment-Resistant - diagnostic imaging Depressive Disorder, Treatment-Resistant - pathology Depressive Disorder, Treatment-Resistant - therapy Drug therapy Female Gray Matter - diagnostic imaging Gray Matter - pathology Gyrus Cinguli - diagnostic imaging Gyrus Cinguli - pathology Hippocampus Hippocampus - diagnostic imaging Hippocampus - pathology Humans Magnetic Resonance Imaging Male Medical equipment industry Mental depression Middle Aged Neurophysiology Outcome Assessment, Health Care Patients Research Paper Retrospective Studies Segmentation Statistical analysis Studies Substantia alba Substantia grisea Thalamus Thalamus - diagnostic imaging Thalamus - pathology Volumetric analysis White Matter - diagnostic imaging White Matter - pathology |
| title | Neuroanatomical predictors of response to subcallosal cingulate deep brain stimulation for treatment-resistant depression |
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