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Abstract #1183

Optimizing Subcallosal Cingulate DBS for Treatment Resistant Depression Based on Structural Connectivity

Ki Sueng Choi1, Patricio Riva Posse2, Paul E. Holtzheimer3, Cameron C. McIntyre4, Xiaoping P. Hu1, Helen S. Mayberg2

1BME, Georgia Institute of Technology / Emory University, Atlanta, GA, United States; 2Psychiatry, Emory University, Atlanta, GA, United States; 3Psychiatry and Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; 4BME, Cleveland Clinic, Cleveland, OH, United States

Bilateral DBS of the subcallosal cingulate cortex results in sustained long-term antidepressant effects for treatment-resistant depression. Clinical response may be improved by more precise targeting along specific white matter tracts based on structural connectivity. The 6 and 24 months responder show connections to bilateral mF and limbic regions. The non-responder shows connections to unilateral mF but insufficient connections to limbic regions. For quantitative SC analysis, responder shows strong probability of connection to mF, bilateral inferior BA10, nucleus accumbens, putamen, and caudate. These results demonstrate that a successful clinical outcome is dependent on both bilateral mF and limbic/subcortical connections.

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Keywords

acquisition activated active address adjacent adjusted affine analyses anatomy antidepressant arch assessed assessments atlas bilateral blue brain calculating chronic cicerone clinic clinical common connection connections connectivity contact contacts contrast corrected correction cortex cortical currently decrease defined depression diffusion distortion eddy effectiveness efficacy electrode electrodes fast findings fitting five frequency frontal functional generate generated green guided head help identifying illustrates implantation improved individual inferior interestingly limbic linear local location long maps mask masks matrix measured medial medical modified month months nearly nonlinear notably nucleus optimizing outcome passing patients placement population positive precise preprocessing previous previously prior probabilistic probability psychiatry pulse quantitative reduce register registered related resistant resp responder responders response scale scanner seeds selected severity skull software space statistical stimulation stop stripped strong structural studies subject subjects superior surgery susceptibility sustained symptom system table target targeting technology template threads threshold tissue tracts transferred transformation treatment underwent unilateral volume white whole year years