PDF(Pubmed)
Abstract：
Treatment-resistant depression is a severe form of major depressive disorder and deep brain stimulation is currently an investigational treatment. The stimulation\'s therapeutic effect may be explained through the functional and structural connectivities between the stimulated area and other brain regions, or to depression-associated networks. In this longitudinal, retrospective study, four female patients with treatment-resistant depression were implanted for stimulation in the nucleus accumbens area at our center. We analyzed the structural and functional connectivity of the stimulation area: the structural connectivity was investigated with probabilistic tractography; the functional connectivity was estimated by combining patient-specific stimulation volumes and a normative functional connectome. These structural and functional connectivity profiles were then related to four clinical outcome scores. At 1-year follow-up, the remission rate was 66%. We observed a consistent structural connectivity to Brodmann area 25 in the patient with the longest remission phase. The functional connectivity analysis resulted in patient-specific R-maps describing brain areas significantly correlated with symptom improvement in this patient, notably the prefrontal cortex. But the connectivity analysis was mixed across patients, calling for confirmation in a larger cohort and over longer time periods.
摘要：
难治性抑郁症是严重抑郁症的一种严重形式，深部脑刺激目前是一种研究性治疗方法。刺激的治疗效果可以通过刺激区域和其他大脑区域之间的功能和结构连接来解释。或者与抑郁症相关的网络。在这个纵向，回顾性研究,我们中心的4例女性难治性抑郁症患者被植入伏隔核区进行刺激.我们分析了刺激区域的结构和功能连通性：通过概率纤维束成像研究了结构连通性；通过结合患者特定的刺激体积和规范的功能连接体来估计功能连通性。然后将这些结构和功能连接谱与四个临床结果评分相关。在1年的随访中，缓解率为66%。在缓解期最长的患者中，我们观察到与Brodmann25区的结构连接一致。功能连接分析导致患者特定的R图，描述与该患者症状改善显着相关的大脑区域。尤其是前额叶皮层.但是连通性分析在不同患者中混合，要求在更大的队列和更长的时间段内进行确认。
