Test-retest reliability of a stimulation-locked evoked response to deep brain stimulation in subcallosal cingulate for treatment resistant depression

• Type of Material: Article
• Authors: Allison Waters, Emory University; Ashan Veerakumar, Emory University; Ki Choi, Emory University; Bryan Howell, Case Western Reserve University; Vineet Tiruvadi, Emory University; Kelly Bijanki, Emory University; Andrea Crowell, Emory University; Patricio Riva Posse, Emory University; Helen Mayberg, Emory University
• Language: English
• Date: 2018-12-01
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2018 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/hbm.24327
• Title of Journal or Parent Work: HUMAN BRAIN MAPPING
• Volume: 39
• Issue: 12
• Start Page: 4844
• End Page: 4856
• Grant/Funding Information: This work was supported by the NIH Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative (UH3NS103550) and the Hope for Depression Research Foundation. The DBS Activa PC+S devices used in this research were donated by Medtronic (Minneapolis, MN).
• Keywords: Radiology, Nuclear Medicine & Medical Imaging; cortico-cortical evoked potential; THALAMUS; ANTERIOR; Science & Technology; Neurosciences; FUNCTIONAL CONNECTIVITY; treatment resistant depression; ACTIVATION; INHIBITION; white matter tractography; subcallosal cingulate cortex; LANGUAGE SYSTEM; POTENTIALS; GYRUS; Neuroimaging; TRANSCRANIAL MAGNETIC STIMULATION; Life Sciences & Biomedicine; forceps minor; Neurosciences & Neurology; stimulation evoked potential; deep brain stimulation; EPILEPSY
• Research Categories: Biology, Neuroscience; Health Sciences, Radiology

Abstract

Deep brain stimulation (DBS) to the subcallosal cingulate cortex (SCC) is an emerging therapy for treatment resistant depression. Precision targeting of specific white matter fibers is now central to the model of SCC DBS treatment efficacy. A method to confirm SCC DBS target engagement is needed to reduce procedural variance across treatment providers and to optimize DBS parameters for individual patients. We examined the reliability of a novel cortical evoked response that is time-locked to a 2 Hz DBS pulse and shows the propagation of signal from the DBS target. The evoked response was detected in four individuals as a stereotyped series of components within 150 ms of a 6 V DBS pulse, each showing coherent topography on the head surface. Test–retest reliability across four repeated measures over 14 months met or exceeded standards for valid test construction in three of four patients. Several observations in this pilot sample demonstrate the prospective utility of this method to confirm surgical target engagement and instruct parameter selection. The topography of an orbital frontal component on the head surface showed specificity for patterns of forceps minor activation, which may provide a means to confirm DBS location with respect to key white matter structures. A divergent cortical response to unilateral stimulation of left (vs. right) hemisphere underscores the need for feedback acuity on the level of a single electrode, despite bilateral presentation of therapeutic stimulation. Results demonstrate viability of this method to explore patient-specific cortical responsivity to DBS for brain-circuit pathologies.