Limbic versus cognitive target for deep brain stimulation in treatment-resistant depression: accumbens more promising than caudate.
European Neuropsychopharmacology. 2014-08-01; 24(8): 1229-1239
DOI: 10.1016/j.euroneuro.2014.05.006
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1. Eur Neuropsychopharmacol. 2014 Aug;24(8):1229-39. doi:
10.1016/j.euroneuro.2014.05.006. Epub 2014 May 20.
Limbic versus cognitive target for deep brain stimulation in treatment-resistant
depression: accumbens more promising than caudate.
Millet B(1), Jaafari N(2), Polosan M(3), Baup N(4), Giordana B(5), Haegelen
C(6), Chabardes S(7), Fontaine D(8), Devaux B(9), Yelnik J(10), Fossati P(11),
Aouizerate B(12), Krebs MO(4), Robert G(1), Jay T(13), Cornu P(14), Vérin M(15),
Drapier S(16), Drapier D(1), Sauleau P(17), Peron J(18), Le Jeune F(19), Naudet
F(20), Reymann JM(21).
Author information:
(1)University Department of Adult Psychiatry, Guillaume Régnier Hospital,
Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes
1, Rennes, France.
(2)Intersector Clinical Psychiatric Research Unit (INSERM U 1084), Psychobiology
of Compulsive Disorders Team, Experimental and Clinical Neurosciences
Laboratory, Henri Laborit Hospital, University of Poitiers, France.
(3)D Villars Ward (Adult Psychiatry), Department of Psychiatry and Neurology,
North Hospital, University Hospital, Grenoble, France.
(4)Adolescent and Young Adult Assessment Center, Sainte-Anne Hospital, Paris,
France.
(5)Psychiatry and Medical Psychology Clinic, University Department of Clinical
Neuroscience, Pasteur University Hospital, Nice, France.
(6)Department of Neurosurgery, Pontchaillou University Hospital, Rennes, France.
(7)Department of Neurosurgery, University Hospital, Grenoble, France.
(8)Department of Neurosurgery, Pasteur University Hospital, Nice, France.
(9)Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.
(10)CRICM UPMC/INSERM UMR S 975, CNRS UMR 7225, La Salpêtrière Hospital, Paris,
France.
(11)Department of Psychiatry, Pitié-Salpêtrière Hospital, Paris, France.
(12)University Department of Adult Psychiatry, Charles Perrens Hospital,
Bordeaux, France.
(13)Inserm U894, Center for Psychiatry and Neuroscience, Paris Descartes
University, Paris, France.
(14)Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France.
(15)Department of Neurology, Pontchaillou University Hosptial, Rennes, France;
Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes,
France.
(16)Department of Neurology, Pontchaillou University Hospital, Rennes, France.
(17)Functional Neurological Exploration Unit, Pontchaillou University Hospital,
Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes
1, Rennes, France.
(18)Swiss Center for Affective Sciences, University of Geneva, Geneva,
Switzerland.
(19)Department of Nuclear Medicine, Eugène Marquis Center, Rennes, France;
Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes,
France.
(20)Clinical Investigation Center (INSERM 0203), Department of Pharmacology,
Pontchaillou University Hospital, Rennes, France; Behavior and Basal Ganglia
Unit (EA-4712), University of Rennes 1, Rennes, France. Electronic address:
.
(21)Clinical Investigation Center (INSERM 0203), Department of Pharmacology,
Pontchaillou University Hospital, Rennes, France.
Comment in
Brain Stimul. 2015 Jul-Aug;8(4):842-3. doi: 10.1016/j.brs.2015.05.004.
High-frequency deep brain stimulation (DBS) represents a major stake for
treatment for treatment-resistant depression (TRD). We describe a preliminary
trial of DBS of two potential brain targets in chronic TRD: the nucleus
accumbens (Acb) and, in the event of failure, the caudate nucleus. Patients were
followed for 6 months before surgery (M0). From M1 to M5, they underwent
stimulation of the Acb target. PET scans allowed us to track metabolic
modifications resulting from this stimulation. The caudate target of
nonresponders was stimulated between M5 and M9. Patients then entered an
extension phase, in which it was possible to adapt stimulation parameters and
treatments. Six patients were included and four were operated on. At M5, none of
the patients were either responders or remitters, but we did observe a decrease
in Hamilton Depression Rating Scale (HDRS) scores. Three patients were switched
to caudate stimulation, but no improvement was observed. During the extension
phase, the Acb target was stimulated for all patients, three of whom exhibited a
significant response. A decrease in glucose metabolism was observed after Acb
stimulation, in the posterior cingulate gyrus, left frontal lobe, superior and
medial gyrus, and bilateral cerebellum. An increase in metabolism was observed
in the bilateral frontal lobe (superior gyrus), left frontal lobe (medial
gyrus), and right limbic lobe (anterior cingulate gyrus). The results of this
trial suggest that Acb is a more promising target than the caudate. NCT01569711.
Copyright © 2014 Elsevier B.V. and ECNP. All rights reserved.
DOI: 10.1016/j.euroneuro.2014.05.006
PMID: 24950819 [Indexed for MEDLINE]