Intraoperative neural signals predict rapid antidepressant effects of deep brain stimulation

• Type of Material: Article
• Authors: Mohammad S. E. Sendi, Emory University; Allison C. Waters, Icahn School of Medicine at Mount Sinai; Vineet Tiruvadi, Emory University; Patricio Riva Posse, Emory University; Andrea Crowell, Emory University; Faical Isbaine, Emory University; John T. Gale, Emory University; Ki Sueng Choi, Emory University; Robert Gross, Emory University; Helen S Mayberg, Emory University; Babak Mahmoudi, Emory University
• Language: English
• Date: 2021-11-03
• Publisher: SPRINGERNATURE
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1038/s41398-021-01669-0
• Title of Journal or Parent Work: TRANSLATIONAL PSYCHIATRY
• Volume: 11
• Issue: 1
• Start Page: 551
• End Page: 551
• Grant/Funding Information: Funding support was provided by the National Institutes of Health, Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative (UH3NS103550), Hope for Depression Research Foundation, and 1R01MH102238, 1R01MH106173. BM was additionally supported by UG3NS100559 and 1R01EB028350. Implanted devices used in this research were donated by Medtronic, Inc. (Minneapolis, MN).
• Keywords: POWER; Science & Technology; GYRUS; ANTERIOR CINGULATE CORTEX; DBS; TERM; Life Sciences & Biomedicine; LONG; TREATMENT-RESISTANT DEPRESSION; Psychiatry; BETA-BAND ACTIVITY; SELECTION
• Research Categories: Biology, Neuroscience; Psychology, Clinical

Abstract

Deep brain stimulation (DBS) of the subcallosal cingulate (SCC) is a promising intervention for treatment-resistant depression (TRD). Despite the failure of a clinical trial, multiple case series have described encouraging results, especially with the introduction of improved surgical protocols. Recent evidence further suggests that tractography targeting and intraoperative exposure to stimulation enhances early antidepressant effects that further evolve with ongoing chronic DBS. Accelerating treatment gains is critical to the care of this at-risk population, and identification of intraoperative electrophysiological biomarkers of early antidepressant effects will help guide future treatment protocols. Eight patients underwent intraoperative electrophysiological recording when bilateral DBS leads were implanted in the SCC using a connectomic approach at the site previously shown to optimize 6-month treatment outcomes. A machine learning classification method was used to discriminate between intracranial local field potentials (LFPs) recorded at baseline (stimulation-naïve) and after the first exposure to SCC DBS during surgical procedures. Spectral inputs (theta, 4–8 Hz; alpha, 9–12 Hz; beta, 13–30 Hz) to the model were then evaluated for importance to classifier success and tested as predictors of the antidepressant response. A decline in depression scores by 45.6% was observed after 1 week and this early antidepressant response correlated with a decrease in SCC LFP beta power, which most contributed to classifier success. Intraoperative exposure to therapeutic stimulation may result in an acute decrease in symptoms of depression following SCC DBS surgery. The correlation of symptom improvement with an intraoperative reduction in SCC beta power suggests this electrophysiological finding as a biomarker for treatment optimization.