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Cingulate dynamics track depression recovery with deep brain stimulation.

Cingulate dynamics track depression recovery with deep brain stimulation.

Authors :
Alagapan S
Choi KS
Heisig S
Riva-Posse P
Crowell A
Tiruvadi V
Obatusin M
Veerakumar A
Waters AC
Gross RE
Quinn S
Denison L
O'Shaughnessy M
Connor M
Canal G
Cha J
Hershenberg R
Nauvel T
Isbaine F
Afzal MF
Figee M
Kopell BH
Butera R
Mayberg HS
Rozell CJ
Source :
Nature [Nature] 2023 Oct; Vol. 622 (7981), pp. 130-138. Date of Electronic Publication: 2023 Sep 20.
Publication Year :
2023

Abstract

Deep brain stimulation (DBS) of the subcallosal cingulate (SCC) can provide long-term symptom relief for treatment-resistant depression (TRD) <superscript>1</superscript> . However, achieving stable recovery is unpredictable <superscript>2</superscript> , typically requiring trial-and-error stimulation adjustments due to individual recovery trajectories and subjective symptom reporting <superscript>3</superscript> . We currently lack objective brain-based biomarkers to guide clinical decisions by distinguishing natural transient mood fluctuations from situations requiring intervention. To address this gap, we used a new device enabling electrophysiology recording to deliver SCC DBS to ten TRD participants (ClinicalTrials.gov identifier NCT01984710). At the study endpoint of 24 weeks, 90% of participants demonstrated robust clinical response, and 70% achieved remission. Using SCC local field potentials available from six participants, we deployed an explainable artificial intelligence approach to identify SCC local field potential changes indicating the patient's current clinical state. This biomarker is distinct from transient stimulation effects, sensitive to therapeutic adjustments and accurate at capturing individual recovery states. Variable recovery trajectories are predicted by the degree of preoperative damage to the structural integrity and functional connectivity within the targeted white matter treatment network, and are matched by objective facial expression changes detected using data-driven video analysis. Our results demonstrate the utility of objective biomarkers in the management of personalized SCC DBS and provide new insight into the relationship between multifaceted (functional, anatomical and behavioural) features of TRD pathology, motivating further research into causes of variability in depression treatment.<br /> (© 2023. The Author(s).)

Details

Language :
English
ISSN :
1476-4687
Volume :
622
Issue :
7981
Database :
MEDLINE
Journal :
Nature
Publication Type :
Academic Journal
Accession number :
37730990
Full Text :
https://doi.org/10.1038/s41586-023-06541-3