4.7 Article

3T MRI of rapid brain activity changes driven by subcallosal cingulate deep brain stimulation

期刊

BRAIN
卷 145, 期 6, 页码 2214-2226

出版社

OXFORD UNIV PRESS
DOI: 10.1093/brain/awab447

关键词

deep brain stimulation; subcallosal cingulate; functional magnetic resonance imaging; depression; anterior cingulate cortex

资金

  1. Canadian Institutes of Health Research [164235]
  2. RR Tasker Chair in Functional Neurosurgery at University Health Network

向作者/读者索取更多资源

Using 3T functional MRI, researchers found that subcallosal cingulate deep brain stimulation can alter activity in brain regions associated with mood, and these changes are correlated with immediate mood fluctuations and long-term antidepressant outcomes.
Using 3T functional MRI, Elias et al. show that subcallosal cingulate DBS acutely alters activity in brain regions implicated in mood, including dorsal anterior cingulate cortex, in patients with symptoms of depression. The observed changes correlate with both immediate mood fluctuations and long-term antidepressant outcomes. Deep brain stimulation targeting the subcallosal cingulate area, a hub with multiple axonal projections, has shown therapeutic potential for treatment-resistant mood disorders. While subcallosal cingulate deep brain stimulation drives long-term metabolic changes in corticolimbic circuits, the brain areas that are directly modulated by electrical stimulation of this region are not known. We used 3.0 T functional MRI to map the topography of acute brain changes produced by stimulation in an initial cohort of 12 patients with fully implanted deep brain stimulation devices targeting the subcallosal cingulate area. Four additional subcallosal cingulate deep brain stimulation patients were also scanned and employed as a validation cohort. Participants underwent resting state scans (n = 78 acquisitions overall) during (i) inactive deep brain stimulation; (ii) clinically optimal active deep brain stimulation; and (iii) suboptimal active deep brain stimulation. All scans were acquired within a single MRI session, each separated by a 5-min washout period. Analysis of the amplitude of low-frequency fluctuations in each sequence indicated that clinically optimal deep brain stimulation reduced spontaneous brain activity in several areas, including the bilateral dorsal anterior cingulate cortex, the bilateral posterior cingulate cortex, the bilateral precuneus and the left inferior parietal lobule (P-Bonferroni < 0.0001). Stimulation-induced dorsal anterior cingulate cortex signal reduction correlated with immediate within-session mood fluctuations, was greater at optimal versus suboptimal settings and was related to local cingulum bundle engagement. Moreover, linear modelling showed that immediate changes in dorsal anterior cingulate cortex, posterior cingulate cortex and precuneus activity could predict individual long-term antidepressant improvement. A model derived from the primary cohort that incorporated amplitude of low-frequency fluctuations changes in these three areas (along with preoperative symptom severity) explained 55% of the variance in clinical improvement in that cohort. The same model also explained 93% of the variance in the out-of-sample validation cohort. Additionally, all three brain areas exhibited significant changes in functional connectivity between active and inactive deep brain stimulation states (P-Bonferroni < 0.01). These results provide insight into the network-level mechanisms of subcallosal cingulate deep brain stimulation and point towards potential acute biomarkers of clinical response that could help to optimize and personalize this therapy.

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