Parameter-based analysis of clinical efficacy of combined bed nucleus of the stria terminalis–nucleus accumbens deep brain stimulation for treatment-resistant depression

作者：Tao Wang, Lulin Dai, Yijie Lai, Fengting Wang, Yingying Zhang, Yuhan Wang, Dianyou Li, Shikun Zhan, Liuguan Bian, Bomin Sun · 发表于：Journal of neurosurgery · 年份：2024 · DOI：10.3171/2023.10.jns231855 · 被引用次数：10 · 研究领域：Neurological disorders and treatments、Transcranial Magnetic Stimulation Studies、Vagus Nerve Stimulation Research

OBJECTIVE: Treatment-resistant depression (TRD) is a severely disabling psychiatric condition that responds poorly to conventional treatments. Deep brain stimulation (DBS) has been proposed for the treatment of patients with TRD in numerous studies. Several deep brain nuclei are considered as potential targets for TRD-DBS, but their clinical efficacy needs further validation. This study carried out dual-target combined stimulation of the bed nucleus of the stria terminalis (BNST) and nucleus accumbens (NAc) to investigate the effectiveness of the treatment for TRD patients. METHODS: An 8-contact DBS electrode was used in the study with a surgical path that crossed the BNST and NAc targets. Stimulation parameters and the corresponding severity of symptoms evaluated by the 17-item Hamilton Depression Rating Scale (HAMD-17) and other scales were obtained at each follow-up. The accuracy of electrode positions, the effect of combined stimulation, and the corresponding stimulation parameters were evaluated. Sweet spot prediction models were used to assess the effective stimulation sites in the treatment. RESULTS: The study included 23 TRD patients undergoing DBS at a single center from March 2021 to May 2023. At the last follow-up (range 4-24 months), 14 patients had responded to the treatment (HAMD-17 score improved ≥ 50%), 7 of whom had achieved clinical remission (HAMD-17 score ≤ 7). Electrode position analysis suggested that the BNST may be more important for the improvement of...