Structural Imaging Evaluation of Subcallosal Cingulate Deep Brain Stimulation for Treatment-resistant Depression

By Kara A. Johnson^1,2; Darren L. Clark, PhD³; Gordon Duffley^1,2; Rajamannar Ramasubbu, MD³; Zelma H.T. Kiss, MD³; and Christopher R. Butson, PhD^1,2,4

¹Department of Bioengineering; ²Scientific Computing & Imaging (SCI) Institute; ³Departments of Clinical Neurosciences and Psychiatry, University of Calgary; ⁴Departments of Neurology and Neurosurgery

Deep brain stimulation (DBS) of the subcallosal cingulate cortex (SCC) is an investigational therapy for treatment-resistant depression (TRD). There is a wide range of response rates for SCC DBS for TRD. The ideal location and extent of stimulation within the SCC to produce substantial therapeutic effects are currently unknown and may vary between patients. We used T1-weighted structural MRI to make between- and within-subject comparisons of volumes of tissue activated (VTAs) relative to structural anatomy to make observations about the effects of stimulation location and settings on clinical response. Our preliminary results suggest that stimulation location and volume relative to T1 structural anatomy alone may not predict clinical response in SCC DBS for TRD. Therapeutic response to SCC DBS may depend on a combination of several factors, such as patient-specific stimulation parameters, duration of stimulation, or other factors that play a role in specific fiber activation. Further analysis is warranted to elucidate whether stimulation locations, parameters, and durations predict therapeutic response to SCC DBS.

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