Multi Targeting Deep Brain Stimulation for Treatment-Resistant Depression: A 22 Month Follow up Case Report: Track 2: Brain Stimulation for Treatment Resistant Depression, Pain, and Parkinson's Disease

ABSTRACT

Introduction: According to WHO, there are more than 300,000,000 people worldwide suffering from depression. It is the world's leading cause of disability and contributes significantly to the overall global burden of disease. 30% of the patients are refractory, being possible candidates for surgical treatment by means of Deep Brain Stimulation (DBS). We present the follow up at 22 months of a patient with Treatment Refractory Depression (TRD) operated on with a new combination of targets. Materials / Methods: The diagnostic criteria used are those established by Mayberg et al DSM IV-TR criteria for major depressive disorder with a major depressive episode of at least 1 year duration, with a minimum score of 20 on the 17-item Hamilton Depression Scale (HAM-D). Result(s) 55-year-old male. HAM-D 26-point. It was decided to simultaneously implant Area 25 (SCG/Cg 25) and the Inferior Thalamic Peduncle (ITP) in order to contemplate the synergistic effect of stimulation of both structures. On December 5, 2018, it was successfully implanted, with previously published techniques, using a deep brain micro register system and stereotactic planning to define the coordinates of each selected target for the implantation of the four tetrapolar electrodes, model 6145 (Abbott) for Area 25 and model 6149 for ITP (Abbott). The electrode implanted in Area 25 was kept lit for 3 months, then only the corresponding to the ITP for an additional 3 months, and finally the four electrodes simultaneously maintaining the stimulation parameters reported in the literature. Post-surgical HAM-D scales were performed, with the following results: * Exclusively Area 25 (21/03/19) = 10 points * Exclusively ITP (13/06/19) = 9 points * Area 25 + ITP (08/08/19) = 14 points. * Area 25 + ITP (19/12/19) = 5 points. * Area 25 + ITP (08/10/20) = 5 points. Discussion(s) The possibility of multiple targets is technically possible and appropriate in very well selected cases. Conclusion(s) The patient showed a statistically significant improvement. Despite maintaining a rating of 5, it is worth mentioning that the patient refers feeling "better" than the previous year considering the time of year (spring), and the burden of the COVID-19 pandemic. This confirms some reports that mention the maintenance of the effect in the long term, even at 8 years, or even an improvement after almost two years can be seen. We consider that the synergism obtained by simultaneous stimulation of both targets could be more effective in terms of control of the depressive state at the long term. Supplemental Data none. Learning Objectives: 1- To present a new therapeutic modality of multitargeting DBS for major depression. 2- To demonstrate that the combination of surgical targets is a possible option in carefully selected patients. 3- To demonstrate that the therapeutic effect is maintained over the time. Keywords depression, deep brain stimulation, Area 25, inferior thalamic peduncle, multitargeting Copyright © 2022