Neuromodulation of the inferior thalamic peduncle for major depression and obsessive compulsive disorder.
Neuromodulation of the inferior thalamic peduncle is a new surgical treatment for major depression and obsessive-compulsive disorder. The inferior thalamic peduncle is a bundle of fibers connecting the orbito-frontal cortex with the non-specific thalamic system in a small area behind the fornix and anterior to the polar reticular thalamic nucleus. Electrical stimulation elicits characteristic frontal cortical responses (recruiting responses and direct current (DC)-shift) that confirm correct localization of this anatomical structure. A female with depression for 23 years and a male with obsessive-compulsive disorder for 9 years had stereotactic implantation of electrodes in the inferior thalamic peduncle and were evaluated over a long-term period. Initial OFF stimulation period (1 month) showed no consistent changes in the Hamilton Depression Scale (HAM-D), Yale Brown Obsessive Compulsive Scale (YBOCS), or Global Assessment of Functioning scale (GAF). The ON stimulation period (3-5 V, 130-Hz frequency, 450-msec pulse width in a continuous program) showed significant decrease in depression, obsession, and compulsion symptoms. GAF improved significantly in both cases. The neuropsychological tests battery showed no significant changes except from a reduction in the perseverative response of the obsessive-compulsive patient and better performance in manual praxias of the female depressive patient. Moderate increase in weight (5 kg on average) was observed in both cases.
Jiménez
F
F
Functional Neurosurgery, Stereotactic and Radiosurgery Unit, Hospital General De México, Mexico City, Mexico. fiacroj@yahoo.com
Velasco
F
F
Salín-Pascual
R
R
Velasco
M
M
Nicolini
H
H
Velasco
A L
AL
Castro
G
G
D000328:Adult; D046690:Deep Brain Stimulation / Q000379:methods*; D003865:Major Depressive Disorder / Q000473:pathology / Q000628:therapy*; D004307:Dose-Response Relationship, Radiation; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000473:pathology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013788:Thalamus / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*