Georgios P Skandalakis1, Christos Koutsarnakis2, Aristotelis V Kalyvas2, Panagiotis Skandalakis3, Elizabeth O Johnson3, George Stranjalis4. 1. Athens Microneurosurgery Laboratory, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurosurgery, Evangelismos General Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens Medical School, Greece; Laboratory for Education and Research in Neurosciences (LERNs), National and Kapodistrian University of Athens Medical School, Greece. Electronic address: gpskandalakis@yahoo.com. 2. Athens Microneurosurgery Laboratory, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurosurgery, Evangelismos General Hospital, National and Kapodistrian University of Athens Medical School, Greece; Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens Medical School, Greece. 3. Department of Anatomy and Surgical Anatomy, National and Kapodistrian University of Athens Medical School, Greece; Laboratory for Education and Research in Neurosciences (LERNs), National and Kapodistrian University of Athens Medical School, Greece. 4. Athens Microneurosurgery Laboratory, National and Kapodistrian University of Athens Medical School, Greece; Department of Neurosurgery, Evangelismos General Hospital, National and Kapodistrian University of Athens Medical School, Greece.
Abstract
BACKGROUND: The habenula is a small, mostly underrated structure in the pineal region. Multidisciplinary findings demonstrate an underlying complex connectivity of the habenula with the rest of the brain, subserving its major role in normal behavior and the pathophysiology of depression. These findings suggest the potential application of "habenular psychosurgery" in the treatment of mental disorders. OBJECTIVE/HYPOTHESIS: The remission of two patients with treatment-resistant major depression treated with deep brain stimulation of the habenula supported the hypothesis that the habenula is an effective target for deep brain stimulation and initiated a surge of basic science research. This review aims to assess the viability of the deep brain stimulation of the habenula as a treatment option for treatment resistant depression. METHODS: PubMed and the Cochrane Library databases were searched with no chronological restrictions for the identification of relevant articles. RESULTS: The results of this review are presented in a narrative form describing the functional neuroanatomy of the human habenula, its implications in major depression, findings of electrode implantation of this region and findings of deep brain stimulation of the habenula for the treatment of depression. CONCLUSION: Data assessing the hypothesis are scarce. Nonetheless, findings highlight the major role of the habenula in normal, as well as in pathological brain function, particularly in depression disorders. Moreover, findings of studies utilizing electrode implantation in the region of the habenula underscore our growing realization that research in neuroscience and deep brain stimulation complement each other in a reciprocal relationship; they are as self-reliant, as much as they depend on each other.
BACKGROUND: The habenula is a small, mostly underrated structure in the pineal region. Multidisciplinary findings demonstrate an underlying complex connectivity of the habenula with the rest of the brain, subserving its major role in normal behavior and the pathophysiology of depression. These findings suggest the potential application of "habenular psychosurgery" in the treatment of mental disorders. OBJECTIVE/HYPOTHESIS: The remission of two patients with treatment-resistant major depression treated with deep brain stimulation of the habenula supported the hypothesis that the habenula is an effective target for deep brain stimulation and initiated a surge of basic science research. This review aims to assess the viability of the deep brain stimulation of the habenula as a treatment option for treatment resistant depression. METHODS: PubMed and the Cochrane Library databases were searched with no chronological restrictions for the identification of relevant articles. RESULTS: The results of this review are presented in a narrative form describing the functional neuroanatomy of the human habenula, its implications in major depression, findings of electrode implantation of this region and findings of deep brain stimulation of the habenula for the treatment of depression. CONCLUSION: Data assessing the hypothesis are scarce. Nonetheless, findings highlight the major role of the habenula in normal, as well as in pathological brain function, particularly in depression disorders. Moreover, findings of studies utilizing electrode implantation in the region of the habenula underscore our growing realization that research in neuroscience and deep brain stimulation complement each other in a reciprocal relationship; they are as self-reliant, as much as they depend on each other.