Reduced limbic connections may contraindicate subgenual cingulate deep brain stimulation for intractable depression.

Full Abstract

In this study, the authors performed deep brain stimulation (DBS) of the subgenual anterior cingulate cortex (SACC) in a patient with a history of bipolar disorder. After a right thalamic stroke, intractable depression without mood elevation or a mixed state developed in this patient. He underwent bilateral SACC DBS and died 16 months afterwards. Anatomical connections were studied in this patient preoperatively and postmortem using diffusion tractography (DT). A comparison of in vivo and high resolution ex vivo connectivity patterns was performed as a measure of the utility of in vivo DT in presurgical planning for DBS. Diagnostic measures included neuropsychological testing, preoperative and ex vivo DT, and macroscopic neuropathological assessment. Post-DBS depression rating scores did not improve. In vivo and ex vivo DT revealed markedly reduced limbic projections from the thalamus and SACC to the amygdala in the right (stroke-affected) hemisphere. A highly selective right mediothalamic lesion was associated with the onset of refractory depression. Reduced amygdalar-thalamic and amygdalar-SACC connections could be a contraindication to DBS for depression. Correspondence between preoperative and higher resolution ex vivo DT supports the validity of DT as a presurgical planning tool for DBS.

Author information

Author/s: McNab, Jennifer A (JA); Voets, Natalie L (NL); Jenkinson, Ned (N); Squier, Waney (W); Miller, Karla L (KL); Goodwin, Guy M (GM); Aziz, Tipu Z (TZ);

Affiliation: Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Department of Clinical Neurology, University of Oxford, UK. jmcnab(-atsign-)fmrib.ox.ac.uk

Journal and publication information

Publication Type: Case Reports; Journal Article; Research Support, Non-U.S. Gov't

Journal: Journal of neurosurgery (J Neurosurg), published in United States. (Language: eng)

Reference: 2009-Oct; vol 111 (issue 4) : pp 780-4

Dates: Created 2009/10/02; Completed 2009/10/23;

PMID: 19284230, status: MEDLINE (last retrieval date: 10/23/2009, IMS Date: )

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