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Individualized rTMS Treatment for Depression using an fMRI-Based Targeting Method
Published on: August 2, 2021
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Metabolic activity in subcallosal cingulate predicts response to deep brain stimulation for depression
Elliot C Brown1,2,3,4,5, Darren L Clark1,2,3,4, Nils D Forkert2,3,6
1Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, AB, Canada.
Summary
Subcallosal cingulate deep brain stimulation (DBS) shows promise for treatment-resistant depression. Higher baseline brain glucose metabolism in the SCC predicted positive outcomes, suggesting it as a potential biomarker for patient selection.
Area of Science:
- Neuroscience
- Psychiatry
- Medical Imaging
Background:
- Subcallosal cingulate (SCC) deep brain stimulation (DBS) is a potential treatment for treatment-resistant depression (TRD).
- Previous open-label studies showed promise, but a large multicenter trial did not replicate these response rates.
- Identifying biomarkers is crucial for improving patient selection and treatment outcomes in TRD.
Purpose of the Study:
- To investigate subcallosal cingulate (SCC) metabolic activity as a predictor and marker of treatment response to SCC DBS in TRD patients.
- To determine if baseline brain glucose metabolism (CMRGlu) in the SCC can predict response to SCC DBS.
- To examine the relationship between changes in SCC metabolic activity and depression symptom severity post-DBS.
Main Methods:
- Utilized [18F] FDG-PET to measure brain glucose metabolism (CMRGlu) at baseline and 6 months post-DBS in 20 TRD patients.
- Employed machine learning (Gaussian naive Bayes classifier with leave-one-out cross-validation) to assess the predictive power of baseline SCC CMRGlu for treatment response.
- Defined responders as a ≥48% reduction in Hamilton Depression Rating Scale scores and analyzed correlations between metabolic changes and symptom improvement.
Main Results:
- Baseline SCC CMRGlu was significantly higher in responders compared to non-responders.
- Machine learning analysis accurately predicted treatment response with 80% accuracy based on baseline SCC CMRGlu.
- A reduction in SCC CMRGlu at 6 months post-DBS correlated significantly with improved depression symptoms (r=0.509, p=0.031).
Conclusions:
- Baseline subcallosal cingulate (SCC) metabolic activity, measured by [18F] FDG-PET, serves as a promising image-based biomarker for predicting response to SCC DBS in treatment-resistant depression.
- This finding supports the potential use of SCC metabolic activity for prospective patient selection in future clinical trials and practice.
- SCC DBS response is associated with changes in brain glucose metabolism, highlighting the neurometabolic effects of this intervention.
