Longitudinal Functional Changes in Treatment-Resistant Depression with SCC Deep Brain Stimulation
Poster No:
21
Submission Type:
Abstract Submission
Authors:
Jungho Cha1, Ki Sueng Choi1, Martijn Figee1, Patricio Riva-Posse2, Brian Kopell1, Helen Mayberg1
Institutions:
1Icahn School of Medicine at Mount Sinai, New York, NY, 2Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
First Author:
Co-Author(s):
Patricio Riva-Posse
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
Atlanta, GA
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
Atlanta, GA
Introduction:
In recent years, advancements in understanding the safety of MRI in deep brain stimulation (DBS) implanted patients have led to more studies exploring the potential of measuring functional and structural changes with chronic stimulation. While previous studies showed that the subcallosal cingulate cortex (SCC) DBS induces long-term metabolic changes in corticolimbic circuits [1-3], but longitudinal alterations in function using resting-state functional MRI (rs-fMRI) remain unknown. This study rigorously investigates longitudinal resting-state functional changes within intrinsic connectivity networks (ICNs) during a 6-month period of SCC DBS for TRD. Emphasizing its significance, the research aims to replicate key findings observed in a previous positron emission tomography (PET) study [3], specifically highlighting alterations in the default mode network (DMN) and salience network (SN).
Methods:
Four TRD patients with fully implanted DBS devices targeting the SCC area underwent 3.0T rs-fMRI at three-time points: baseline, 1-month, and 3-months of chronic stimulation. Additionally, two patients underwent an extra time point at 6 months of chronic stimulation. Image analysis was conducted using the Analysis of Functional NeuroImages (AFNI)[4]. To assess regional neural activity, the Amplitude of Low-Frequency Fluctuations (ALFF) and Regional Homogeneity (ReHo) approaches within individual gray matter regions were applied. We utilized 17 standard ICNs derived from a published resting-state functional connectivity study in healthy adults [5]. ALFF and ReHo values for each ICN were calculated by averaging all gray matter voxels within each ICN, excluding artifact voxels affected by DBS lead and cable. Linear mixed models, accounting for individual variability as random intercepts, were employed to examine longitudinal functional changes and their correlation with the Hamilton Depression Rating Scale 17 (HAMD) scores.
Results:
Significant longitudinal alterations in local activity were identified within the Salience B and Default A networks. Particularly, the local activity, encompassing ALFF and ReHo, exhibited substantial increments at the 1-month mark of chronic stimulation. In the Salience B network, significant time effects were observed for both ReHo (p=0.014) and ALFF (p=0.002). Similarly, within the Default A network, both ReHo (p=0.002) and ALFF (p=0.003) showed significant time effects. These functional alterations also showed significant negative correlations with HAMD scores. Specifically, in the Salience B network, both ReHo (p=0.028) and ALFF (p=0.003) demonstrated negative correlations with HAMD scores. In the Default A network, significant negative correlations were also observed for both ReHo (p=0.003) and ALFF (p=0.003) with HAMD scores.
Conclusions:
We observed significant longitudinal changes in local activity within the Salience B and Default A networks following SCC DBS. Notably, there was a marked increase in ReHo and ALFF at the 1-month chronic stimulation. While the direction of these changes opposes a previous PET study [3], the observed pattern underscores that both the SN and DMN undergo significant alterations. This replication of distinct network changes underscores the complexity and meaningful neural shifts induced by SCC DBS in these networks. The dynamic changes in network activity were negatively associated with HAMD scores, indicating a potential link between the observed neural activity changes and symptomatic improvements in TRD. The local brain activity changes in SN and DMN with chronic stimulation highlights the complexity of the neural mechanisms involved in the therapeutic effects of DBS.
Brain Stimulation:
Deep Brain Stimulation 1
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 2
Keywords:
FUNCTIONAL MRI
Psychiatric Disorders
Other - Deep Brain Stimulation
1|2Indicates the priority used for review
Provide references using author date format
2 Lozano AM, Mayberg HS, Giacobbe P, Hamani C, Craddock RC, Kennedy SH. Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression. Biol Psychiatry. 2008;64(6):461-7.
3 Cha J, Choi KS, Rajendra JK, McGrath CL, Riva-Posse P, Holtzheimer PE, et al. Whole brain network effects of subcallosal cingulate deep brain stimulation for treatment-resistant depression. Mol Psychiatry. 2023.
4 Cox RW. AFNI: software for analysis and visualization of functional magnetic resonance neuroimages. Comput Biomed Res. 1996;29(3):162-73.
5 Yeo BT, Krienen FM, Sepulcre J, Sabuncu MR, Lashkari D, Hollinshead M, et al. The organization of the human cerebral cortex estimated by intrinsic functional connectivity. J Neurophysiol. 2011;106(3):1125-65.