Abstract
Objective
Major depression affects millions of people worldwide and has important social and
economic consequences. Since up to 30% of patients do not respond to several lines
of antidepressive drugs, deep brain stimulation (DBS) has been evaluated for the management
of treatment-resistant depression (TRD). The superolateral branch of the medial forebrain
bundle (slMFB) appears as a “hypothesis-driven target” because of its role in the
reward-seeking system, which is dysfunctional in depression. Although initial results
of slMFB-DBS from open-label studies were promising and characterized by a rapid clinical
response, long-term outcomes of neurostimulation for TRD deserve particular attention.
Therefore, we performed a systematic review focused on the long-term outcome of slMFB-DBS.
Materials and Methods
A literature search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses
criteria was conducted to identify all studies reporting changes in depression scores
after one-year follow-up and beyond. Patient, disease, surgical, and outcome data
were extracted for statistical analysis. The Montgomery-Åsberg Depression Rating Scale
(ΔMADRS) was used as the clinical outcome, defined as percentage reduction from baseline
to follow-up evaluation. Responders’ and remitters’ rates were also calculated.
Results
From 56 studies screened for review, six studies comprising 34 patients met the inclusion
criteria and were analyzed. After one year of active stimulation, ΔMADRS was 60.7% ±
4%; responders’ and remitters’ rates were 83.8% and 61.5%, respectively. At the last
follow-up, four to five years after the implantation, ΔMADRS reached 74.7% ± 4.6%.
The most common side effects were stimulation related and reversible with parameter
adjustments.
Conclusions
slMFB-DBS appears to have a strong antidepressive effect that increases over the years.
Nevertheless, to date, the overall number of patients receiving implantations is limited,
and the slMFB-DBS surgical technique seems to have an important impact on the clinical
outcome. Further multicentric studies in a larger population are needed to confirm
slMFB-DBS clinical outcomes.
Keywords
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Article info
Publication history
Published online: April 26, 2023
Accepted:
March 20,
2023
Received in revised form:
March 11,
2023
Received:
December 18,
2022
Publication stage
In Press Corrected ProofFootnotes
Source(s) of financial support: The authors reported no funding sources.
Conflict of Interest: The authors reported no conflict of interest.
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© 2023 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.
