Axonal pathways linked to therapeutic and nontherapeutic outcomes during psychiatric deep brain stimulation

J. Luis Lujan, Ashutosh Chaturvedi, Donald A. Malone, Ali R. Rezai, Andre G. Machado, Cameron C. Mcintyre

Research output: Contribution to journalArticle

43 Scopus citations

Abstract

Objective:: The underlying hypothesis of our work is that specific clinical neuropsychiatric benefits can be achieved by selective activation of specific axonal pathways during deep brain stimulation (DBS). As such, the goal of this study was to develop a method for identifying axonal pathways whose activation is most likely necessary for achieving therapeutic benefits during DBS. Experimental design:: Our approach combined clinical data, diffusion tensor tractography, and computer models of patient-specific neurostimulation to identify particular axonal pathways activated by DBS and determine their correlations with individual clinical outcome measures. We used this method to evaluate a cohort of seven treatment-resistant depression patients treated with DBS of the ventral anterior internal capsule and ventral striatum (VC/VS). Principal observations:: Clinical responders exhibited five axonal pathways that were consistently activated by DBS. All five pathways coursed lateral and medial to the VS or dorsal and lateral to the nucleus accumbens; however, details of their specific trajectories differed. Similarly, one common pathway was identified across nonresponders. Conclusions:: Our method and preliminary results provide important background for studies aiming to expand scientific characterization of neural circuitry associated with specific psychiatric outcomes from DBS. Furthermore, identification of pathways linked to therapeutic benefit provides opportunities to improve clinical selection of surgical targets and stimulation settings for DBS devices.

Original languageEnglish (US)
Pages (from-to)958-968
Number of pages11
JournalHuman Brain Mapping
Volume33
Issue number4
DOIs
StatePublished - Apr 1 2012

Keywords

  • Axonal pathways
  • Clinical outcomes
  • Deep brain stimulation
  • Depression
  • Neural activation
  • Psychiatric disorders

ASJC Scopus subject areas

  • Anatomy
  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Neurology
  • Clinical Neurology

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