Limbic versus cognitive target for deep brain stimulation in treatment-resistant depression: accumbens more promising than caudate.

Bruno Millet (1, 2) , Nematollah Jaafari (3) , Mircea Polosan (4) , Nicolas Baup (5) , Bruno Giordana (6) , Claire Haegelen (7) , Stephan Chabardes (4) , Denys Fontaine (6) , Bertrand Devaux (5) , Jérome Yelnik (8) , Philippe Fossati (9) , Bruno Aouizerate (10) , Marie Odile Krebs (5) , Gabriel Robert (1, 2) , Thérèse Jay (11) , Philippe Cornu (9) , Marc Vérin (1, 12) , Sophie Drapier (7) , Dominique Drapier (1, 2) , Paul Sauleau (13, 1) , Julie Peron (14) , Florence Le Jeune (1, 15) , Florian Naudet (16, 1) , Jean Michel Reymann (16)

1 Comportement et noyaux gris centraux = Behavior and Basal Ganglia [Rennes]
2 Service de Psychiatrie de l'adulte [Rennes]
3 LNEC [Poitiers] - Laboratoire de neurosciences expérimentales et cliniques
4 CHUGA - Centre Hospitalier Universitaire [CHU Grenoble]
5 Service de psychiatrie
6 CHU - Hôpital Pasteur [Nice]
7 Service de neurochirurgie [Rennes] = Neurosurgery [Rennes]
8 CRICM - Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière
9 CHU Pitié-Salpêtrière [AP-HP]
10 Centre hospitalier Charles Perrens [Bordeaux]
11 U894 - Centre de Psychiatrie et Neurosciences
12 Service de Neurologie [Rennes] = Neurology [Rennes]
13 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
14 UNIGE - Université de Genève = University of Geneva
15 Département de médecine nucléaire [Rennes]
16 CIC - Centre d'Investigation Clinique [Rennes]

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.

Mots clés: Treatment-resistant depression; Caudate; Deep brain stimulation; Therapeutic trial; Accumbens

Domaines: Sciences du Vivant [q-bio]

Bruno Millet, Nematollah Jaafari, Mircea Polosan, Nicolas Baup, Bruno Giordana, et al.. Limbic versus cognitive target for deep brain stimulation in treatment-resistant depression: accumbens more promising than caudate.. European Neuropsychopharmacology, 2014, 24 (8), pp.1229-39. ⟨10.1016/j.euroneuro.2014.05.006⟩. ⟨hal-01133833⟩