Distance to white matter trajectories is associated with treatment response to internal capsule deep brain stimulation in treatment-refractory depression

NeuroImage: Clinical

Matthan W.A. Caan¹  Bart de Kwaasteniet¹  Samuel J. Natarajan²  P. Richard Schuurman³  Judy Luigjes⁴  Isidoor O. Bergfeld⁵  Damiaan Denys⁵  Guido A. van Wingen⁶  Pepijn van den Munckhof⁶  Luka C. Liebrand⁶ 

[1] Amsterdam Brain and Cognition, Nieuwe Achtergracht 129 B, Amsterdam, Netherlands;Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, Netherlands;Corresponding author at: Department of Biomedical Engineering and Physics, Amsterdam UMC – location AMC, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands.;Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, Netherlands;Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, Netherlands;Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, Netherlands;

关键词: Deep brain stimulation;    Treatment-refractory depression;    Anterior limb of the internal capsule;    Diffusion MRI;    Tractography;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Deep brain stimulation (DBS) is an innovative treatment for treatment-refractory depression. DBS is usually targeted at specific anatomical landmarks, with patients responding to DBS in approximately 50% of cases. Attention has recently shifted to white matter tracts to explain DBS response, with initial open-label trials targeting white matter tracts yielding much higher response rates (>70%). Objective/Hypothesis: Our aim was to associate distance to individual white matter tracts around the stimulation target in the ventral anterior limb of the internal capsule to treatment response. Methods: We performed diffusion magnetic resonance tractography of the superolateral branch of the medial forebrain bundle and the anterior thalamic radiation in fourteen patients that participated in our randomized clinical trial. We combined the tract reconstructions with the postoperative images to identify the DBS leads and estimated the distance between tracts and leads, which we subsequently associated with treatment response. Results: Stimulation closer to both tracts was significantly correlated to a larger symptom decrease (r = 0.61, p = 0.02), suggesting that stimulation more proximal to the tracts was beneficial. Biophysical modelling indicated that 37.5% of tracts were even outside the volume of activated tissue. There was no difference in lead placement with respect to anatomical landmarks, which could mean that differences in treatment response were driven by individual differences in white matter anatomy. Conclusions: Our results suggest that deep brain stimulation of the ventral anterior limb of the internal capsule could benefit from targeting white matter bundles. We recommend acquiring diffusion magnetic resonance data for each individual patient.

【 授权许可】

Unknown