Universität zu Köln

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:	Creators Email ORCID ORCID Put Code Merkl, Angela UNSPECIFIED UNSPECIFIED UNSPECIFIED Aust, Sabine UNSPECIFIED orcid.org/0000-0002-2638-161X UNSPECIFIED Schneider, Gerd-Helge UNSPECIFIED UNSPECIFIED UNSPECIFIED Visser-Vandewalle, Veerle UNSPECIFIED UNSPECIFIED UNSPECIFIED Horn, Andreas UNSPECIFIED orcid.org/0000-0002-0695-6025 UNSPECIFIED Kuehn, Andrea A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhn, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Bajbouj, Malek UNSPECIFIED orcid.org/0000-0002-0073-3322 UNSPECIFIED
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:	Keywords Language VENTRAL CAPSULE/VENTRAL STRIATUM; MEDIAL FOREBRAIN-BUNDLE; PREFRONTAL CORTEX; ANTERIOR CINGULATE; DISORDER; OUTCOMES; TRACTOGRAPHY; MULTICENTER; ACTIVATION; PREDICTS Multiple languages Clinical Neurology; Psychiatry Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/19768