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Using probabilistic tractography to target the subcallosal cingulate cortex in patients with treatment resistant
Evangelia Tsolaki1, Randall Espinoza2, Nader Pouratian3
1Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
Psychiatry Research. Neuroimaging
|February 1, 2017
Summary
Deep brain stimulation (DBS) for treatment-resistant depression (TRD) may improve with precise targeting. This study identified a tractography-optimized target (TOT) closer to the active electrodes in a patient who responded to subcallosal cingulate (SCC) DBS.
Area of Science:
- Neuroscience
- Neurosurgery
- Psychiatry
Background:
- Deep brain stimulation (DBS) targeting the subcallosal cingulate (SCC) shows variable efficacy for treatment-resistant depression (TRD).
- Suboptimal electrode placement may contribute to the lack of therapeutic response in some patients undergoing SCC DBS for TRD.
Purpose of the Study:
- To identify a patient-specific, tractography-optimized target (TOT) for SCC DBS in treatment-resistant depression (TRD).
- To investigate the relationship between electrode placement relative to the TOT and clinical response in TRD patients receiving SCC DBS.
Main Methods:
- Utilized voxel-wise probabilistic tractography to assess connectivity between the SCC and four depression-implicated brain regions.
- Defined the tractography-optimized target (TOT) based on connectivity data.
- Compared the proximity of DBS lead placement and stimulation to the TOT in a responder versus a non-responder.
Main Results:
- The responder's DBS leads were positioned closer to the identified TOT compared to the non-responder.
- This patient-specific, data-driven approach generated tomographic maps to guide targeting and programming.
Conclusions:
- Optimizing DBS targeting using tractography-based methods may enhance treatment efficacy for TRD.
- This approach offers a potential strategy to improve outcomes for patients undergoing SCC DBS.
