Zusammenfassung
BACKGROUND: A preliminary report in six patients suggested that deep
brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG)
may provide benefit in treatment-resistant depression (TRD). We now
report the results of these and an additional 14 patients with extended
follow-up. METHODS: Twenty patients with TRD underwent serial assessments
before and after SCG DBS. We determined the percentage of patients
who achieved a response (50\% or greater reduction in the 17-item
Hamilton Rating Scale for Depression HRSD-17) or remission (scores
of 7 or less) after surgery. We also examined changes in brain metabolism
associated with DBS, using positron emission tomography. RESULTS:
There were both early and progressive benefits to DBS. One month
after surgery, 35\% of patients met criteria for response with 10\%
of patients in remission. Six months after surgery, 60\% of patients
were responders and 35\% met criteria for remission, benefits that
were largely maintained at 12 months. Deep brain stimulation therapy
was associated with specific changes in the metabolic activity localized
to cortical and limbic circuits implicated in the pathogenesis of
depression. The number of serious adverse effects was small with
no patient experiencing permanent deficits. CONCLUSIONS: This study
suggests that DBS is relatively safe and provides significant improvement
in patients with TRD. Subcallosal cingulate gyrus DBS likely acts
by modulating brain networks whose dysfunction leads to depression.
The procedure is well tolerated and benefits are sustained for at
least 1 year. A careful double-blind appraisal is required before
the procedure can be recommended for use on a wider scale.
- aged,neurosurgical
- anatomy
- brain
- callosum,deep
- cerebral
- cinguli,gyrus
- cinguli:
- cortex,cerebral
- cortex:
- disorder,
- histology,gyrus
- illness
- imaging,male,middle
- index,stereotaxic
- major,depressive
- major:
- metabolism,cerebral
- metabolism,depressive
- metabolism,gyrus
- metabolism,limbic
- methods,depressive
- of
- physiopathology,corpus
- physiopathology,depressive
- physiopathology,magnetic
- procedures,positron-emission
- resistance,female,glucose,glucose:
- resonance
- stimulation,deep
- stimulation:
- surgery,drug
- surgery,humans,limbic
- system,limbic
- system:
- techniques
- tomography,questionnaires,severity
- \&
Nutzer