Depresión Resistente y Neurocirugía: Estado del Arte de la Estimulación Cerebral Profunda del Área Subgenual (Área 25)

Facundo Villamil; Jorge Mandolesi; Melanie Catena Baudo; Pablo Paolinelli; Maria Florencia Vidal; Elsa Costanzo

doi:10.47924/neurotarget2024463

Authors

Facundo Villamil Department of Neurosurgery. FLENI. CABA. Argentina. https://orcid.org/0000-0002-2248-9324
Jorge Mandolesi Department of Neurosurgery. FLENI. CABA. Argentina.
Melanie Catena Baudo Department of Neurology. FLENI. CABA. Argentina.
Pablo Paolinelli Department of Neurosurgery. Italian Hospital. CABA. Argentina.
Maria Florencia Vidal Department of Psychiatry. FLENI. CABA. Argentina.
Elsa Costanzo Department of Psychiatry. FLENI. CABA. Argentina.

DOI:

https://doi.org/10.47924/neurotarget2024463

Keywords:

Deep brain stimulation, treatment-resistant depression, subgenual area, tractography, white matter, connectome

Abstract

Introduction and Objectives. Treatment-resistant depression (TRD) is a debilitating condition that does not respond to conventional antidepressant treatments. Deep brain stimulation (DBS) of the subgenual area (Cg25) has emerged as a promising option for these patients. This study aims to evaluate the safety, efficacy, and underlying mechanisms of DBS in the Cg25 region for treating TRD.
Methods. A systematic literature review was conducted using PubMed, Scopus, and the Cochrane Library. Studies and reviews on DBS for TRD published between 2005 and 2024 were included. Data on mechanisms of action, clinical efficacy, adverse effects, and predictive factors of success were extracted and analyzed.
Results. A total of 14 open-label studies and three randomized controlled trials (RCTs) investigating DBS of the subgenual area were included. The overall response rate was 56% and the remission rate was 35%. Variability in outcomes was related to different stimulation parameters and the chronicity of the disease. Studies highlighted the importance of targeting stimulation towards specific white matter tracts to optimize clinical outcomes. The use of probabilistic tractography to map the optimal "connectome prototype" has shown promising improvements in response and remission rates.
Conclusions. DBS of the subgenual area shows potential as a treatment for TRD, particularly when using connectome-guided targeting approaches. Further research is needed to optimize stimulation parameters and validate predictive biomarkers of response.

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