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Author Notes:

Corresponding Author: Ki Sueng Choi, PhD, Department of Psychiatry and Behavioral Sciences, 101 Woodruff Cir NE WMRB Suite 4303, Atlanta, GA 30306, Tel: 404-727-5602, Fax: 404-727-8264, kchoi8@emory.edu.

Ki Sueng Choi and Patricio Riva-Posse contributed equally to this work.

Authors Ki Sueng Choi and Patricio Riva-Posse made substantial contributions to protocol design, acquisition of data, analysis of data, interpretation of data, and manuscript preparation.

Author Robert E. Gross participated in surgical planning, design of protocol for intraoperative testing.

Author Helen S. Mayberg made important contributions to entire study conception and design, intellectual content, interpretation of data, and manuscript preparation.

We thank the following individuals for their contributions to the study from which these data were derived: psychiatrists Steve Garlow, MD PhD, Andrea Crowell, MD, image and data analyst Justin Rajendra and research coordinator Sinead Quinn.

Financial Disclosures. Dr. Mayberg has received consulting and intellectual licensing fees from St. Jude Medical Inc. Robert E. Gross has received consulting fees from Boston Scientific Neuromodulation, St. Jude Medical Neuromodulation, and Medtronic/Lilly. All other authors report no commercial or financial relationships that could be construed as a potential conflict of interest.


Research Funding:

Grant Support: Dana Foundation and the Hope for Depression Research Foundation, NIH R01 NS059736.

Device Donation: St Jude Medical, Inc.


  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Neurosciences & Neurology
  • DBS
  • depression
  • diffusion MRI
  • tractography
  • cingulate cortex
  • ventromedial frontal cortex
  • mood
  • biomarker

Mapping the "Depression Switch" During Intraoperative Testing of Subcallosal Cingulate Deep Brain Stimulation


Journal Title:

JAMA Neurology


Volume 72, Number 11


, Pages 1252-1260

Type of Work:

Article | Post-print: After Peer Review


Importance: The clinical utility of monitoring behavioral changes during intraoperative testing of acute subcallosal cingulate deep brain stimulation (DBS) is unknown. Objective: To characterize structural connectivity correlates of DBS evoked behavioral effects using probabilistic tractography. Design: Categorization of acute behavioral effects was conducted during DBS implantation surgery for treatment-resistant depression in a randomized and blinded testing session. Post-hoc analyses of the structural tractography patterns mediating distinct categories of evoked behavioral effects were defined. Setting: Intra-operative testing during DBS surgery for depression at Emory University. Participants: 9 adult participants with chronic treatment-resistant depression undergoing DBS surgery. Main Outcomes and Measures: Categorization of stimulation-induced transient behavioral effects and delineation of the shared white matter tracts mediating response subtypes. Results: Two stereotypical behavior patterns were identified: changes in interoceptive (noted changes in body state) and in exteroceptive awareness (shift in attention from patient to others). Structural connectivity showed that 'best' responses had a pattern of connections to bilateral ventromedial frontal cortex (via uncinate fasciculus and forceps minor) and cingulate cortex (via cingulum bundle) while 'salient' contacts had only cingulate involvement. Conclusions and Relevance: This analysis of acute intraoperative behaviors in SCC DBS, and the subsequent identification of unique connectivity patterns may provide a potential biomarker to guide and optimize surgical implantation and to refine and optimize algorithms for selection of contacts in chronic stimulation.

Copyright information:

© 2015 American Medical Association. All rights reserved.

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