A prospective study of deep brain stimulation of lateral habenula nucleus for the treatment of refractory depression
Objective To investigate the efficacy and safety of deep brain stimulation of lateral habenula nucleus(LHb-DBS)for the treatment of refractory depression.Methods A prospective study was conducted on 6 patients with refractory depression who underwent deep brain stimulation of LHb-DBS in the Department of Neurosurgery of the First Medical Center of PLA General Hospital from March 2021 to April 2022.The Hamilton Depression Rating Scale(HDRS)-17,Hamilton Anxiety scale(HAMA),Montgomery-Åsberg Depression Rating Scale(MADRS),Pittsburgh Sleep Quality Index(PSQI),Quick Inventory of Depressive Symptomatology-Self-Report(QIDS-SR)and Global Assessment Function(GAF)were used for assessment 1 month before surgery and 1,3,6,9,12,and 15 months after surgery respectively.Complications related to surgery and stimulation were also documented.Results All 6 patients successfully underwent surgery.Five patients were followed up to 15 months after start-up of the DBS device,and one case was followed up to 1 month after start-up.At 1 month post start-up,the HDRS-17 score(average improvement rate:60.3％),HAMA score(average improvement rate:59.6％),MADRS score(average improvement rate:61.1％)and QIDS-SR score(average improvement rate:55.2％)were all decreased compared with the preoperative baseline,while the GAF score(average improvement rate:46.9％)was increased.In the follow-up of 3-15 months after start-up,compared with the preoperative baseline,the average improvement rate of depression-related scale HDRS-17,MADRS and QIDS-SR scores in 5 patients was 60.3％-67.6％,64.7％-79.4％and 47.4％-63.2％.For anxiety,the average improvement rate of HAMA score ranged from 57.7％to 71.6％.In terms of sleep,the average improvement rate of PSQI score was 17.2％-31.7％.The GAF score was increased by 47.6％-87.6％.During the perioperative period and follow-up period,there were no cases of surgery-related complications such as intraoperative hemorrhage,ischemia,or wound infection,and no device-related adverse events were observed.During the treatment period,stimulus-related adverse events were recorded in 4 patients,which were relieved after adjusting the stimulus contacts and stimulation parameters.Conclusions The treatment of patients with refractory depression with LHb-DBS can improve depression,anxiety and quality of life.No serious complications related to surgery or stimulation have been observed.
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