Patricio Riva-Posse1, Cory S Inman2, Ki Sueng Choi3, Andrea L Crowell4, Robert E Gross5, Stephan Hamann6, Helen S Mayberg7. 1. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, 30322, GA, USA. Electronic address: privapo@emory.edu. 2. Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road, Atlanta, 30322, GA, USA; Department of Psychology, Emory University, 36 Eagle Row, Atlanta, 30322, GA, USA. 3. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, 10029, NY, USA. 4. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, 30322, GA, USA. 5. Department of Neurosurgery, Emory University School of Medicine, 1365 Clifton Road, Atlanta, 30322, GA, USA; Department of Neurology, Emory University School of Medicine, 1365 Clifton Road, Atlanta, 30322, GA, USA; Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University School of Medicine, 1760 Haygood Dr., Atlanta, 30322, GA, USA. 6. Department of Psychology, Emory University, 36 Eagle Row, Atlanta, 30322, GA, USA. 7. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, 30322, GA, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, New York, 10029, NY, USA.
Abstract
BACKGROUND: Subcallosal cingulate deep brain stimulation (SCC DBS) is an experimental treatment for severe depression. Surgery is performed with awake patients and intraoperative stimulation produces acute behavioral responses in select contacts. While there have been reports on the relationship between acute intraoperative behaviors and their relation to the location of the contacts, there are no descriptions of the physiological changes that accompany them. OBJECTIVE: The present study sought to examine these physiological readouts, and their association with the anatomical substrates that generated them. METHODS: Nine patients with severe, treatment-resistant depression were tested intraoperatively. The stimulation protocol consisted of 12 three-minute, sham-controlled, double-blind trials. Changes in heart rate and skin conductance were recorded during each stimulation cycle. Probabilistic tractography between the stimulated contacts and predefined regions of the mood regulation network was performed. RESULTS: Acute intraoperative SCC stimulation produced increases in autonomic sympathetic response that correlated with the salience of the behavioral responses. The autonomic changes were observed within seconds of initiating acute stimulation and prior to verbalization of subjective experiences. The probabilistic tractography analysis suggested that structural connectivity between the stimulated area and the midcingulate cortex is the primary pathway that mediates autonomic responsivity to SCC DBS. CONCLUSIONS: These findings demonstrate that acute SCC stimulation produces autonomic and behavioral changes in the operating room that are explained by the modulation of networks associated with long term antidepressant response. Intraoperative autonomic recordings paired with careful behavioral observations and precise anatomical mapping aid in the identification and classification of the intraoperative phenomena.
BACKGROUND: Subcallosal cingulate deep brain stimulation (SCC DBS) is an experimental treatment for severe depression. Surgery is performed with awake patients and intraoperative stimulation produces acute behavioral responses in select contacts. While there have been reports on the relationship between acute intraoperative behaviors and their relation to the location of the contacts, there are no descriptions of the physiological changes that accompany them. OBJECTIVE: The present study sought to examine these physiological readouts, and their association with the anatomical substrates that generated them. METHODS: Nine patients with severe, treatment-resistant depression were tested intraoperatively. The stimulation protocol consisted of 12 three-minute, sham-controlled, double-blind trials. Changes in heart rate and skin conductance were recorded during each stimulation cycle. Probabilistic tractography between the stimulated contacts and predefined regions of the mood regulation network was performed. RESULTS: Acute intraoperative SCC stimulation produced increases in autonomic sympathetic response that correlated with the salience of the behavioral responses. The autonomic changes were observed within seconds of initiating acute stimulation and prior to verbalization of subjective experiences. The probabilistic tractography analysis suggested that structural connectivity between the stimulated area and the midcingulate cortex is the primary pathway that mediates autonomic responsivity to SCC DBS. CONCLUSIONS: These findings demonstrate that acute SCC stimulation produces autonomic and behavioral changes in the operating room that are explained by the modulation of networks associated with long term antidepressant response. Intraoperative autonomic recordings paired with careful behavioral observations and precise anatomical mapping aid in the identification and classification of the intraoperative phenomena.
Authors: Sameer A Sheth; Kelly R Bijanki; Brian Metzger; Anusha Allawala; Victoria Pirtle; Joshua A Adkinson; John Myers; Raissa K Mathura; Denise Oswalt; Evangelia Tsolaki; Jiayang Xiao; Angela Noecker; Adriana M Strutt; Jeffrey F Cohn; Cameron C McIntyre; Sanjay J Mathew; David Borton; Wayne Goodman; Nader Pouratian Journal: Biol Psychiatry Date: 2021-11-22 Impact factor: 12.810