A Patient with a Resistant Major Depression Disorder Treated with Deep Brain Stimulation in the Inferior Thalamic Peduncle

ABSTRACT OBJECTIVE AND IMPORTANCE: The present report explored the effect of electrical stimulation on the inferior thalamic peduncle in a patient with resistant major depression disorder (MDD). CLINICAL PRESENTATION: This report refers to a 49-year-old woman with a history of recurrent episodes of major depression for 20 years (12 episodes and 2 hospitalizations), fulfilling Diagnostic and Statistical Manual of Mental Disorders, 4th edition, revised, criteria for MDD; in addition, the patient met criteria for borderline personality disorder and bulimia. Her longest episode of depression with suicidal ideation began 5 years before surgery. The patient's symptom array responded poorly to different combinations of antidepressants, cognitive therapy, and electroconvulsive therapy, which induced improvement only for short periods of time. Immediately before surgery, her Global Assessment of Functioning score was 20 and her Hamilton Depression Scale score ranged from 33 to 42. The patient was proposed for surgery for MDD. INTERVENTION: The patient had bilateral eight-contact electrodes stereotactically implanted for stimulation of areas at and around the inferior thalamic peduncle. Electrode position was corroborated by unilateral electrical stimulation searching for recruiting responses and regional direct current shifts in the electroencephalogram. Recording electrodes were replaced by tetrapolar electrodes for deep brain stimulation and connected to an internalized stimulation system for continuous bipolar stimulation at 130 Hz, 0.45 milliseconds, 2.5 V. Bimonthly follow-up included psychiatric and neuropsychological evaluations performed over the course of 24 months. After 8 months of ON stimulation, the patient entered a double-blind protocol with stimulators turned OFF. Improvement of depression measured by the Hamilton Depression Scale score was evident after initial placement of electrodes without electrical stimulation. Depression relapsed partially at the end of the first week. Electrical stimulation further improved depression, normalizing depression scores and neuropsychological performance. Patient depression scores ranked between 2 and 8 during 8 months of ON stimulation without antidepressant medication. After stimulation was turned OFF, spontaneous fluctuations in patient symptoms reflected by Hamilton Depression Scale and Global Assessment of Functioning scores were documented; these fluctuations disappeared after stimulation was turned on by Month 20. CONCLUSION: Complicated patients with comorbid conditions are common referrals to psychosurgery services. In this report, we present promising results of electrical stimulation of the inferior thalamic peduncle to treat recurrent unipolar depression in a patient with MDD and borderline personality disorder who responded poorly to treatment.

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Electrocortical and behavioral responses elicited by acute electrical stimulation of inferior thalamic peduncle and nucleus reticularis thalami in a patient with major depression disorder

Clinical Neurophysiology ◽

10.1016/j.clinph.2005.10.023 ◽

2006 ◽

Vol 117 (2) ◽

pp. 320-327 ◽

Cited By ~ 27

Author(s):

Marcos Velasco ◽

Francisco Velasco ◽

Fiacro Jiménez ◽

José D. Carrillo-Ruiz ◽

Ana Luisa Velasco ◽

...

Keyword(s):

Electrical Stimulation ◽

Major Depression ◽

Behavioral Responses ◽

Major Depression Disorder ◽

Nucleus Reticularis ◽

Depression Disorder ◽

Stimulation Of

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Gender Differences in [123I]-ADAM Binding to Serotonin Transporters in Patients with Major Depression Before and After Treatment with Citalopram

European Psychiatry ◽

10.1016/s0924-9338(09)70937-x ◽

2009 ◽

Vol 24 (S1) ◽

pp. 1-1

Author(s):

K. Uebelhack ◽

L. Franke ◽

N. Herold ◽

M. Plotkin ◽

H. Amthauer ◽

...

Keyword(s):

Gender Differences ◽

Major Depression ◽

Depression Scale ◽

Brain Regions ◽

Hamilton Depression Scale ◽

Serotonin Transporters ◽

Before And After ◽

Males And Females ◽

Depression Disorder ◽

Analyze Data

Aims:The aim was to determine the relation between characteristics of [123I]-ADAM binding to serotonin transporters (SERT) in several brain regions to different symptoms in patients diagnosed with major depressive disorder (MDD) and to analyze data for males and females separately. Differences of [123I]-ADAM binding in patients before and after treatment with Selective Serotonin Reuptake Inhibitor (SSRI) antidepressant Citalopram were assessed.Method:12 non medicated patients (5 females and 7 males) diagnosed with MDD were examined by SPECT with specific Serotonin transporter radioligand [123I]-ADAM before and after treatment with SSRI Citalopram. We administered the dose of 10 mg Citalopram per day intravenously at first day, followed by a 6 days period of oral application. After 7 days of treatment patients were examined for second time with SPECT. The relationships between [123I]-ADAM binding and different aspects of major depression represented by HAMD items, assessed twice by Hamilton Depression-Scale (HAMD) once at baseline and second after treatment period, were evaluated.Results:We found significant correlations with significant gender differences between singular sub items of HAMD and indices of [123I]-ADAM binding in midbrain before and after treatment. These findings points to the need of data analysis separately in males and females. No correlations between HAMD total scores at baseline and indices were found.Conclusion:SERT availability for 123-ADAM binding in the midbrain in drug naives as well as in treated patients with major depression disorder seems to be related to intensity of sub items in the HAMD and the outcome of treatment.

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Belastungen in der Kindheit und dissoziative Symptomatik bei Patienten mit psychischen Störungen

Zeitschrift für Klinische Psychologie und Psychotherapie ◽

10.1026/1616-3443/a000183 ◽

2013 ◽

Vol 42 (1) ◽

pp. 24-33 ◽

Cited By ~ 4

Author(s):

Johanna Fiess ◽

Astrid Steffen ◽

Christian Pietrek ◽

Brigitte Rockstroh

Keyword(s):

Major Depression ◽

Major Depression Disorder ◽

Dissoziative Symptome ◽

Kindheit Und Jugend ◽

Depression Disorder

Theoretischer Hintergrund: Dissoziative Symptome treten bei verschiedenen psychischen Störungen auf und werden bei einigen Störungen mit traumatischen Erfahrungen assoziiert. Fragestellung: Wird der Zusammenhang zwischen dissoziativer Symptomatik und belastenden Erfahrungen moduliert durch die Art der Erfahrung und das Alter zum Zeitpunkt der Belastung? Methode: Bei 82 Patienten (Borderline-Persönlichkeitsstörung, BPS; Major Depression Disorder, MDD) und 54 gesunden Kontrollpersonen wurden per Interview belastende Erfahrungen während Kindheit und Jugend (3 – 16 Jahre) ermittelt. Zusammenhänge zwischen Belastung und dissoziativer Symptomatik wurden regressionsanalytisch unter Berücksichtigung von Diagnose und komorbider Posttraumatischer Belastungsstörung (PTBS) untersucht. Ergebnisse: Dissoziative Symptomatik korreliert bei BPD und MDD (mit komorbider PTBS) positiv mit emotionalem (neben sexuellem) Missbrauch und mit Belastungen in der Pubertät. Schlussfolgerung: Therapeutische Berücksichtigung emotionaler und pubertärer Belastung könnte die (Behandlung erschwerende) dissoziative Symptomatik reduzieren.

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Psychomodulation by bilateral deep brain stimulation of the lateral habenula in a patient with long-lasting, therapy-refractory major depression

Pharmacopsychiatry ◽

10.1055/s-0029-1240212 ◽

2009 ◽

Vol 42 (05) ◽

Cited By ~ 1

Author(s):

A Sartorius ◽

K Kiening ◽

C von Gall ◽

U Haberkorn ◽

AW Unterberg ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Major Depression ◽

Brain Stimulation ◽

Lateral Habenula ◽

Deep Brain ◽

Stimulation Of

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Efficacy of an Active Implementation Process of a Computerized CPG of Major Depression Disorder in Primary Care

10.26226/morressier.5885d713d462b8028d89112f ◽

2017 ◽

Author(s):

Myriam Cavero

Keyword(s):

Primary Care ◽

Major Depression ◽

Implementation Process ◽

Major Depression Disorder ◽

Active Implementation ◽

Depression Disorder

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Deep Brain Stimulation of the Posterior Insula in Chronic Pain: A Theoretical Framework

Brain Sciences ◽

10.3390/brainsci11050639 ◽

2021 ◽

Vol 11 (5) ◽

pp. 639

Author(s):

David Bergeron ◽

Sami Obaid ◽

Marie-Pierre Fournier-Gosselin ◽

Alain Bouthillier ◽

Dang Khoa Nguyen

Keyword(s):

Chronic Pain ◽

Electrical Stimulation ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

High Frequency ◽

Brain Lesion ◽

Low Frequency ◽

Posterior Insula ◽

Deep Brain ◽

Stimulation Of

Introduction: To date, clinical trials of deep brain stimulation (DBS) for refractory chronic pain have yielded unsatisfying results. Recent evidence suggests that the posterior insula may represent a promising DBS target for this indication. Methods: We present a narrative review highlighting the theoretical basis of posterior insula DBS in patients with chronic pain. Results: Neuroanatomical studies identified the posterior insula as an important cortical relay center for pain and interoception. Intracranial neuronal recordings showed that the earliest response to painful laser stimulation occurs in the posterior insula. The posterior insula is one of the only regions in the brain whose low-frequency electrical stimulation can elicit painful sensations. Most chronic pain syndromes, such as fibromyalgia, had abnormal functional connectivity of the posterior insula on functional imaging. Finally, preliminary results indicated that high-frequency electrical stimulation of the posterior insula can acutely increase pain thresholds. Conclusion: In light of the converging evidence from neuroanatomical, brain lesion, neuroimaging, and intracranial recording and stimulation as well as non-invasive stimulation studies, it appears that the insula is a critical hub for central integration and processing of painful stimuli, whose high-frequency electrical stimulation has the potential to relieve patients from the sensory and affective burden of chronic pain.

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