title: Deep brain stimulation of the posterior gyrus rectus region for treatment resistant depression.
abstract: BACKGROUND
  Deep brain stimulation (DBS) represents an alternative symptomatic treatment for major depressive disorder in case of failure of pharmacotherapy. The sub-genual cingulate-Brodmann area 25 (CG-25), is one of the most widely used targets for electrode implantation. Given the diverging clinical outcome after DBS, there is a pressing need for in-depth study of brain anatomy and function allowing accurate and reliable prognosis before surgery.
  
  
  METHODS
  We studied five treatment-resistant major depressive disorder patients planned to undergo DBS targeting the CG-25. Before surgery, we acquired high-resolution magnetic resonance (MR) diffusion-weighted images for each patient followed by post-surgery MRI for electrode localization. To estimate individual anatomical connectivity pattern of the active contact location we performed probabilistic diffusion tractography intra-individually. We then correlated connectivity patterns with outcome assessed with standardized clinical tests. Connectivity results were compared between DBS responders and non-responders.
  
  
  RESULTS
  We observed in one patient an excellent clinical response after DBS of the bilateral posterior gyrus rectus rather than the initially targeted CG-25. The remaining four patients with DBS of the CG-25 were considered as non-responders. In the case patient, we demonstrate a strong connectivity of the stimulated regions to the medial prefrontal cortex (mPFC), which contrasted to the lower mPFC connectivity in non-responders.
  
  
  CONCLUSIONS
  Confirmation in larger cohorts is needed.
  
  
  CONCLUSIONS
  We propose the posterior gyrus rectus as viable alternative new target for DBS in major depressive disorder. High connectivity between target and mPFC supports the pivotal role of this region in brain networks involved in mood processing.
authors.affiliation: Department of Neurology, Charité University Medicine Berlin, Campus Virchow (CVK), 13353 Berlin, Germany; LREN - Département des Neurosciences Cliniques, CHUV, Université de Lausanne, 1011 Lausanne, Switzerland.
authors.forename: Ettore A
authors.initials: EA
authors.lastname: Accolla
authors.affiliation: Department of Psychiatry, Center for Affective Sciences (CAS), Charité and Freie Universität Berlin, Campus Benjamin Franklin (CBF), 14050 Berlin, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Aust
authors.affiliation: Department of Neurology, Charité University Medicine Berlin, Campus Virchow (CVK), 13353 Berlin, Germany; Department of Psychiatry, Center for Affective Sciences (CAS), Charité and Freie Universität Berlin, Campus Benjamin Franklin (CBF), 14050 Berlin, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Merkl
authors.affiliation: Department of Neurology, Charité University Medicine Berlin, Campus Virchow (CVK), 13353 Berlin, Germany.
authors.forename: Gerd-Helde
authors.initials: GH
authors.lastname: Schneider
authors.affiliation: Department of Neurology, Charité University Medicine Berlin, Campus Virchow (CVK), 13353 Berlin, Germany.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Kühn
authors.affiliation: Department of Psychiatry, Center for Affective Sciences (CAS), Charité and Freie Universität Berlin, Campus Benjamin Franklin (CBF), 14050 Berlin, Germany.
authors.forename: Malek
authors.initials: M
authors.lastname: Bajbouj
authors.affiliation: LREN - Département des Neurosciences Cliniques, CHUV, Université de Lausanne, 1011 Lausanne, Switzerland; Max Planck Institute for Human Cognitive and Brain Science, 04103 Leipzig, Germany. Electronic address: bogdan.draganski@gmail.com.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Draganski
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D003865:Major Depressive Disorder / Q000503:physiopathology / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000503:physiopathology / Q000628:therapy*; D038524:Diffusion Magnetic Resonance Imaging; D056324:Diffusion Tensor Imaging; D004567:Electrodes, Implanted; D005260:Female; D006179:Gyrus Cinguli / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000502:physiology; D016896:Treatment Outcome
keywords: Deep brain stimulation; Gyrus rectus; Major depression disorder; Medial prefrontal cortex; Probabilistic diffusion tractography; Subgenual cingulate