Current perspectives on tractography-guided deep brain stimulation for the treatment of mood disorders

ABSTRACT

Introduction

Deep brain stimulation (DBS) is an emerging therapy for mood disorders, particularly treatment-resistant depression (TRD). Different brain areas implicated in depression-related brain networks have been investigated as DBS targets and variable clinical outcomes highlight the importance of target identification. Tractography has provided insight into how DBS modulates disorder-related brain networks and is being increasingly used to guide DBS for psychiatric disorders.

Areas Covered

In this perspective, an overview of the current state of DBS for TRD and the principles of tractography is provided. Next, a comprehensive review of DBS targets is presented with a focus on tractography. Finally, the challenges and future directions of tractography-guided DBS are discussed.

Expert Opinion

Tractography-guided DBS is a promising tool for improving DBS outcomes for mood disorders. Tractography is particularly useful for targeting patient-specific white matter tracts that are not visible using conventional structural MRI. Developments in tractography methods will help refine DBS targeting for TRD and may facilitate symptom-specific precision neuromodulation. Ultimately, the standardization of tractography methods will be essential to transforming DBS into an established therapy for mood disorders.

KEYWORDS:

• Diffusion tensor imaging
• diffusion weighted imaging
• major depressive disorder
• neuromodulation
• psychiatric neurosurgery
• treatment-resistant depression

Declaration of interest

JL Chan was supported by a Parkinson’s Foundation Institutional Movement Disorders Fellowship. EH Middlebrooks has received research support from Varian Medical Systems and Vigil Neuroscience and is a consultant and advisory board member for Boston Scientific, Varian Medical Systems, and Cortechs.ai. MS Okun serves as Medical Advisor for the Parkinson’s Foundation and has received research grants from the NIH, Parkinson’s Foundation, Michael J. Fox Foundation, the Parkinson Alliance, the Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. He is an associate editor for New England Journal of Medicine Journal Watch Neurology and JAMA Neurology. MS Okun has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, Perseus, Robert Rose, Oxford, and Cambridge. He has participated in continuing medical education and educational activities on movement disorders sponsored by WebMD/Medscape, RMEI Medical Education, the American Academy of Neurology, the International Parkinson and Movement Disorder Society, Mediflix, and Vanderbilt University. The institution and not MS Okun receives grants from industry. He has participated as a site PI and/or co-I for several NIH, foundation, and industry sponsored trials over the years, but has not received honoraria. JK Wong has received research support from the NIH. Finally, Medtronic and NeuroPace have donated devices for several NIH studies at the University of Florida. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.