Emerging Outlook on Personalized Neuromodulation for Depression: Insights From Tractography-Based Targeting.
Biol Psychiatry Cogn Neurosci Neuroimaging
; 9(8): 754-764, 2024 Aug.
Article
em En
| MEDLINE
| ID: mdl-38679323
ABSTRACT
BACKGROUND:
Deep brain stimulation has shown promise in treating individual patients with treatment-resistant depression, but larger-scale trials have been less successful. Here, we created what is, to our knowledge, the largest meta-analysis with individual patient data to date to explore whether the use of tractography enhances the efficacy of deep brain stimulation for treatment-resistant depression.METHODS:
We systematically reviewed 1823 articles, selecting 32 that contributed data from 366 patients. We stratified the individual patient data based on stimulation target and use of tractography. Using 2-way type III analysis of variance, Welch's 2-sample t tests, and mixed-effects linear regression models, we evaluated changes in depression severity 1 year (9-15 months) postoperatively and at last follow-up (4 weeks to 8 years) as assessed by depression scales.RESULTS:
Tractography was used for medial forebrain bundle (MFB) (n = 17 tractography/32 total), subcallosal cingulate (SCC) (n = 39 tractography/241 total), and ventral capsule/ventral striatum (n = 3 tractography/41 total) targets; it was not used for bed nucleus of stria terminalis (n = 11), lateral habenula (n = 10), and inferior thalamic peduncle (n = 1). Across all patients, tractography significantly improved mean depression scores at 1 year (p < .001) and last follow-up (p = .009). Within the target cohorts, tractography improved depression scores at 1 year for both MFB and SCC, though significance was met only at the α = 0.1 level (SCC ß = 15.8%, p = .09; MFB ß = 52.4%, p = .10). Within the tractography cohort, patients with MFB tractography showed greater improvement than patients with SCC tractography (72.42 ± 7.17% vs. 54.78 ± 4.08%) at 1 year (p = .044).CONCLUSIONS:
Our findings underscore the promise of tractography in deep brain stimulation for treatment-resistant depression as a method for personalization of therapy, supporting its inclusion in future trials.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Estimulação Encefálica Profunda
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Imagem de Tensor de Difusão
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Transtorno Depressivo Resistente a Tratamento
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article