Merkl, Angela, Aust, Sabine ORCID: 0000-0002-2638-161X, Schneider, Gerd-Helge, Visser-Vandewalle, Veerle, Horn, Andreas ORCID: 0000-0002-0695-6025, Kuehn, Andrea A., Kuhn, Jens and Bajbouj, Malek ORCID: 0000-0002-0073-3322 (2018). Deep brain stimulation of the subcallosal cingulate gyrus in patients with treatment-resistant depression: A double-blinded randomized controlled study and long-term follow-up in eight patients. J. Affect. Disord., 227. S. 521 - 530. AMSTERDAM: ELSEVIER SCIENCE BV. ISSN 1573-2517

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Abstract

Background: Deep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG) is an experimental approach in treatment-resistant depression (TRD). Short-term results of efficacy in DBS are incongruent and studies investigating long-term effects are warranted. Methods: We assessed efficacy of SCG-DBS in eight patients randomized into a delayed-onset group (sham-DBS four weeks) and a non-delayed-onset group. The primary outcome measure was improvement on the Hamilton Depression Rating-Scale (HAMD-24-item-version). Response was defined as HAMD-24 reduction of at least 50% compared to baseline. Assessment was double-blind for a period of eight weeks and after 6,-12,-24,- and 28,months open-label. Results: The average improvement in HAMD-24 scores after 6,-12,- and 24-months were 34%, 25%, and 37%. After 6 months, HAMD-24 revealed a significant difference (P = .022) and 37.5% of the patients were responders. After 12 months, HAMD-24 scores dropped, but no significant difference was observed. After 24 months, a significant improvement was found (P = .041). After the four weeks lasting sham vs. DBS-ON period, there was no group difference (P = .376) in HAMD-24 and patients did not improve during sham stimulation. Patients were followed until 28 months and two up to 4 years under SCG-DBS and average response rate was 51%, whereas two patients were remitters (33,3%). Limitations: The small sample size limited the statistical power and external validity. Conclusions: Long-term improvement after SCG-DBS revealed a stable effect. There was no significant difference in response rates between the delayed and non-delayed-onset group. DBS for TRD remains experimental and longitudinal investigations of large samples are needed.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Merkl, AngelaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Aust, SabineUNSPECIFIEDorcid.org/0000-0002-2638-161XUNSPECIFIED
Schneider, Gerd-HelgeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Visser-Vandewalle, VeerleUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Horn, AndreasUNSPECIFIEDorcid.org/0000-0002-0695-6025UNSPECIFIED
Kuehn, Andrea A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kuhn, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bajbouj, MalekUNSPECIFIEDorcid.org/0000-0002-0073-3322UNSPECIFIED
URN: urn:nbn:de:hbz:38-197689
DOI: 10.1016/j.jad.2017.11.024
Journal or Publication Title: J. Affect. Disord.
Volume: 227
Page Range: S. 521 - 530
Date: 2018
Publisher: ELSEVIER SCIENCE BV
Place of Publication: AMSTERDAM
ISSN: 1573-2517
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
VENTRAL CAPSULE/VENTRAL STRIATUM; MEDIAL FOREBRAIN-BUNDLE; PREFRONTAL CORTEX; ANTERIOR CINGULATE; DISORDER; OUTCOMES; TRACTOGRAPHY; MULTICENTER; ACTIVATION; PREDICTSMultiple languages
Clinical Neurology; PsychiatryMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/19768

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