Highlights
- •Autonomic changes with SCC DBS correspond to the salience of behavioral responses.
- •These changes are evidence of the distant effects of SCC DBS in midcingulate cortex.
- •These findings aid in the optimal selection of contacts and parameters in SCC DBS surgery.
Abstract
Background
Subcallosal cingulate deep brain stimulation (SCC DBS) is an experimental treatment
for severe depression. Surgery is performed with awake patients and intraoperative
stimulation produces acute behavioral responses in select contacts. While there have
been reports on the relationship between acute intraoperative behaviors and their
relation to the location of the contacts, there are no descriptions of the physiological
changes that accompany them.
Objective
The present study sought to examine these physiological readouts, and their association
with the anatomical substrates that generated them.
Methods
Nine patients with severe, treatment-resistant depression were tested intraoperatively.
The stimulation protocol consisted of 12 three-minute, sham-controlled, double-blind
trials. Changes in heart rate and skin conductance were recorded during each stimulation
cycle. Probabilistic tractography between the stimulated contacts and predefined regions
of the mood regulation network was performed.
Results
Acute intraoperative SCC stimulation produced increases in autonomic sympathetic response
that correlated with the salience of the behavioral responses. The autonomic changes
were observed within seconds of initiating acute stimulation and prior to verbalization
of subjective experiences. The probabilistic tractography analysis suggested that
structural connectivity between the stimulated area and the midcingulate cortex is
the primary pathway that mediates autonomic responsivity to SCC DBS.
Conclusions
These findings demonstrate that acute SCC stimulation produces autonomic and behavioral
changes in the operating room that are explained by the modulation of networks associated
with long term antidepressant response. Intraoperative autonomic recordings paired
with careful behavioral observations and precise anatomical mapping aid in the identification
and classification of the intraoperative phenomena.
Keywords
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Article Info
Publication History
Published online: January 25, 2019
Accepted:
January 22,
2019
Received in revised form:
December 11,
2018
Received:
February 5,
2018
Identification
Copyright
© 2019 Published by Elsevier Inc.
