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3T MRI of rapid brain activity changes driven by subcallosal cingulate deep brain stimulation.
Gavin J B Elias1,2, Jürgen Germann1,2, Alexandre Boutet1,2,3
1Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.
Brain : a Journal of Neurology
|December 17, 2021
Summary
Deep brain stimulation for mood disorders modulates brain activity in key areas like the dorsal anterior cingulate cortex. These acute changes predict long-term antidepressant improvement, aiding personalized treatment.
Area of Science:
- Neuroscience
- Psychiatry
- Medical Imaging
Background:
- Deep brain stimulation (DBS) of the subcallosal cingulate area shows promise for treatment-resistant mood disorders.
- The precise brain regions directly affected by subcallosal cingulate DBS are not fully understood.
- Understanding these network-level effects is crucial for optimizing DBS therapy.
Purpose of the Study:
- To map the acute brain changes induced by subcallosal cingulate deep brain stimulation (scC-DBS) using functional MRI.
- To identify brain areas modulated by scC-DBS and explore their relationship with mood fluctuations and clinical outcomes.
- To investigate potential acute biomarkers for predicting long-term antidepressant response to scC-DBS.
Main Methods:
- Functional MRI (fMRI) was used to assess brain activity in 12 patients with scC-DBS devices during inactive, optimal, and suboptimal stimulation.
- Analysis focused on the amplitude of low-frequency fluctuations (ALFF) during resting-state scans.
- A validation cohort of 4 additional patients was included to confirm findings.
Main Results:
- Clinically optimal scC-DBS reduced spontaneous brain activity in the dorsal anterior cingulate cortex, posterior cingulate cortex, precuneus, and inferior parietal lobule.
- Reduced activity in the dorsal anterior cingulate cortex correlated with mood changes and was linked to cingulum bundle engagement.
- Changes in the dorsal anterior cingulate cortex, posterior cingulate cortex, and precuneus predicted long-term antidepressant improvement, with a predictive model explaining 55% of variance in the primary cohort and 93% in the validation cohort.
- Significant functional connectivity changes were observed in these areas between active and inactive DBS states.
Conclusions:
- Subcallosal cingulate deep brain stimulation acutely modulates activity in specific corticolimbic and parietal regions.
- Immediate changes in dorsal anterior cingulate cortex, posterior cingulate cortex, and precuneus activity serve as reliable predictors of long-term antidepressant response.
- These findings offer insights into scC-DBS mechanisms and highlight potential biomarkers for personalized treatment optimization.
