title: Limbic versus cognitive target for deep brain stimulation in treatment-resistant depression: accumbens more promising than caudate.
abstract: High-frequency deep brain stimulation (DBS) represents a major stake for treatment for treatment-resistant depression (TRD). We describe a preliminary trial of DBS of two potential brain targets in chronic TRD: the nucleus accumbens (Acb) and, in the event of failure, the caudate nucleus. Patients were followed for 6 months before surgery (M0). From M1 to M5, they underwent stimulation of the Acb target. PET scans allowed us to track metabolic modifications resulting from this stimulation. The caudate target of nonresponders was stimulated between M5 and M9. Patients then entered an extension phase, in which it was possible to adapt stimulation parameters and treatments. Six patients were included and four were operated on. At M5, none of the patients were either responders or remitters, but we did observe a decrease in Hamilton Depression Rating Scale (HDRS) scores. Three patients were switched to caudate stimulation, but no improvement was observed. During the extension phase, the Acb target was stimulated for all patients, three of whom exhibited a significant response. A decrease in glucose metabolism was observed after Acb stimulation, in the posterior cingulate gyrus, left frontal lobe, superior and medial gyrus, and bilateral cerebellum. An increase in metabolism was observed in the bilateral frontal lobe (superior gyrus), left frontal lobe (medial gyrus), and right limbic lobe (anterior cingulate gyrus). The results of this trial suggest that Acb is a more promising target than the caudate. NCT01569711.
authors.affiliation: University Department of Adult Psychiatry, Guillaume Régnier Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Millet
authors.affiliation: Intersector Clinical Psychiatric Research Unit (INSERM U 1084), Psychobiology of Compulsive Disorders Team, Experimental and Clinical Neurosciences Laboratory, Henri Laborit Hospital, University of Poitiers, France.
authors.forename: Nematollah
authors.initials: N
authors.lastname: Jaafari
authors.affiliation: D Villars Ward (Adult Psychiatry), Department of Psychiatry and Neurology, North Hospital, University Hospital, Grenoble, France.
authors.forename: Mircea
authors.initials: M
authors.lastname: Polosan
authors.affiliation: Adolescent and Young Adult Assessment Center, Sainte-Anne Hospital, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Baup
authors.affiliation: Psychiatry and Medical Psychology Clinic, University Department of Clinical Neuroscience, Pasteur University Hospital, Nice, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Giordana
authors.affiliation: Department of Neurosurgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Haegelen
authors.affiliation: Department of Neurosurgery, University Hospital, Grenoble, France.
authors.forename: Stephan
authors.initials: S
authors.lastname: Chabardes
authors.affiliation: Department of Neurosurgery, Pasteur University Hospital, Nice, France.
authors.forename: Denys
authors.initials: D
authors.lastname: Fontaine
authors.affiliation: Department of Neurosurgery, Sainte-Anne Hospital, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Devaux
authors.affiliation: CRICM UPMC/INSERM UMR S 975, CNRS UMR 7225, La Salpêtrière Hospital, Paris, France.
authors.forename: Jérome
authors.initials: J
authors.lastname: Yelnik
authors.affiliation: Department of Psychiatry, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Fossati
authors.affiliation: University Department of Adult Psychiatry, Charles Perrens Hospital, Bordeaux, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Aouizerate
authors.affiliation: Adolescent and Young Adult Assessment Center, Sainte-Anne Hospital, Paris, France.
authors.forename: Marie Odile
authors.initials: MO
authors.lastname: Krebs
authors.affiliation: University Department of Adult Psychiatry, Guillaume Régnier Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Robert
authors.affiliation: Inserm U894, Center for Psychiatry and Neuroscience, Paris Descartes University, Paris, France.
authors.forename: Thérèse
authors.initials: T
authors.lastname: Jay
authors.affiliation: Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cornu
authors.affiliation: Department of Neurology, Pontchaillou University Hosptial, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Vérin
authors.affiliation: Department of Neurology, Pontchaillou University Hospital, Rennes, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Drapier
authors.affiliation: University Department of Adult Psychiatry, Guillaume Régnier Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Drapier
authors.affiliation: Functional Neurological Exploration Unit, Pontchaillou University Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Sauleau
authors.affiliation: Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.
authors.forename: Julie
authors.initials: J
authors.lastname: Peron
authors.affiliation: Department of Nuclear Medicine, Eugène Marquis Center, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Le Jeune
authors.affiliation: Clinical Investigation Center (INSERM 0203), Department of Pharmacology, Pontchaillou University Hospital, Rennes, France; Behavior and Basal Ganglia Unit (EA-4712), University of Rennes 1, Rennes, France. Electronic address: floriannaudet@gmail.com.
authors.forename: Florian
authors.initials: F
authors.lastname: Naudet
authors.affiliation: Clinical Investigation Center (INSERM 0203), Department of Pharmacology, Pontchaillou University Hospital, Rennes, France.
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Reymann
mesh_terms: D000328:Adult; D001703:Biophysics; D002421:Caudate Nucleus / Q000000981:diagnostic imaging / Q000502:physiology*; D003071:Cognition / Q000502:physiology*; D046690:Deep Brain Stimulation / Q000379:methods*; D003863:Depression / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009714:Nucleus Accumbens / Q000000981:diagnostic imaging / Q000502:physiology*; D049268:Positron-Emission Tomography; D011446:Prospective Studies
keywords: Accumbens; Caudate; Deep brain stimulation; Therapeutic trial; Treatment-resistant depression