Citation

Millet B, Jaafari N, Polosan M, Baup N, Giordana B, Haegelen C, Chabardes S, Fontaine D, Devaux B, Yelnik J, Fossati P, Aouizerate B, Krebs MO, Robert G, Jay T, Cornu P, Vérin M, Drapier S, Drapier D, Sauleau P, Peron J, Jeune FL, Naudet F, Reymann JM. Eur. Neuropsychopharmacol. 2014; 24(8): 1229-1239.

Copyright

(Copyright © 2014, Elsevier Publishing)

DOI

10.1016/j.euroneuro.2014.05.006

PMID

unavailable

Abstract

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. © 2014 Elsevier B.V. and ECNP.

Language: en

Keywords

Humans; Adult; Female; Male; Middle Aged; adult; human; cognition; Depression; female; male; Prospective Studies; Magnetic Resonance Imaging; Cognition; Neuropsychological Tests; psychotherapy; suicidal ideation; depression; patient safety; food intake; suicide attempt; Follow-Up Studies; major depression; lithium; clinical trial; Treatment-resistant depression; neuroimaging; pain; article; neuroleptic agent; human cell; pathophysiology; psychologic test; priority journal; headache; middle aged; anxiety disorder; sleep disorder; nuclear magnetic resonance imaging; electroconvulsive therapy; physiology; follow up; weight gain; Hamilton scale; multicenter study; prospective study; feeding behavior; glucose; positron emission tomography; neuropsychological test; thyroid hormone; Beck Depression Inventory; buspirone; paresthesia; glucose metabolism; monotherapy; increased appetite; pindolol; body mass; treatment response; brain depth stimulation; memory disorder; caudate nucleus; libido disorder; Deep Brain Stimulation; procedures; Deep brain stimulation; serotonin noradrenalin reuptake inhibitor; iproniazid; Hamilton Anxiety Scale; brain metabolism; therapy resistance; Positron-Emission Tomography; preoperative period; scintiscanning; nucleus accumbens; Nucleus Accumbens; Caudate Nucleus; Imaging, Three-Dimensional; three dimensional imaging; multicenter study (topic); treatment resistant depression; Accumbens; biophysics; Biophysics; Caudate; nerve stimulator; posterior cingulate; Therapeutic trial