"DBS of the subcallosal cingulate (SCC) is a promising intervention for treatment-resistant depression," Dr. Helen Mayberg of the Icahn School of Medicine at Mount Sinai in New York City and colleagues write in Translational Psychiatry. "Despite the failure of a clinical trial, multiple case series have described encouraging results, especially with the introduction of improved surgical protocols."
"Accelerating treatment gains is critical to the care of this at-risk population, and identification of intraoperative electrophysiological biomarkers of early antidepressant effects will help guide future treatment protocols," they state.
To uncover a potential biomarker, the team studied eight patients undergoing intraoperative electrophysiological recording when bilateral DBS leads were implanted in the SCC at a site previously shown to optimize six-month treatment outcomes.
They used a machine learning classification strategy to discriminate between intracranial local field potentials (LFPs) recorded at baseline (stimulation-naïve) and after the first exposure to SCC DBS during the surgical procedure.
Spectral inputs (theta, 4-8 Hz; alpha, 9-12 Hz; and beta, 13-30 Hz) were then evaluated for their importance to the classifier's success, and tested as predictors of the antidepressant response.
After one week, the team observed a 45.6% decline in depression scores. Investigating further, they determined that this early antidepressant response correlated with a decrease in SCC LFP beta power, which also contributed most to the classifier success.
The authors conclude, "Intraoperative exposure to therapeutic stimulation may result in an acute decrease in symptoms of depression following SCC DBS surgery. The correlation of symptom improvement with an intraoperative reduction in SCC beta power suggests this electrophysiological finding as a biomarker for treatment optimization."
Dr. Mayberg told Reuters Health by email, "Our team...continues to work to refine the SCC DBS strategy. This paper provides new evidence to help guide further refinements using electrophysiological biomarkers of early response effect."
"We have an active ongoing experimental trial using new devices that allow recording of this same LFP signal from the SCC during chronic stimulation," she added. "This allows us to track the trajectory of recovery over time."
"Our goal is that these studies will provide important new insights for eventual larger studies that can reach more patients in need," she said. "There are no ongoing industry sponsored trials of DBS for depression at the current time, (although) there are several teams in the US with small experimental trials testing several different approaches."
Dr. Pierre-François D'Haese, director of digital health and imaging analytics at West Virginia University Rockefeller Neuroscience Institute in Morgantown, commented in an email to Reuters Health, "The study of the neural system at a personal level is key to understanding the underlying mechanisms involved in brain disorders."
"The effectiveness of any focused treatment of depression requires detailed understanding of the micro-anatomical connectivity, as demonstrated in this report," he said. "Recordings of neuron activity during surgery, and from an implanted brain device (DBS), provides a unique opportunity to gain insight into how to optimize the modulation of the brain and control disorders such as depression or addiction."
"We must continue to advance important research like this and utilize brain recordings using advanced DBS technology to better understand these conditions, identify biomarkers, and develop new treatments," Dr. D'Haese concluded.
SOURCE: https://go.nature.com/30btB28 Translational Psychiatry, online November 3, 2021
By Marilynn Larkin
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