Tractography analysis of subcallosal cingulate DBS for treatment-resistant depression using normative connectome data
Bibliographic record
Abstract
Abstract SCC-DBS for treatment-resistant depression has demonstrated sustained response and remission rates. SCC-DBS targeting evolved from anatomy-based to connectome-based targeting, now stimulating convergence of three (forceps minor (FM), cingulum bundle (CB), and subcortical-junction (SJ)) WM pathways, with improved clinical efficacy. However, there is response variability that might be explained by differences in white matter (WM) activation pathways. We evaluated the relationship of WM activation pathways to clinical improvement in a large cohort of patients using normative-connectome data. Based on changes in HDRS-17 defined at 1 year time point (50±32%), fifty-one patients were analyzed and divided into four groups: remitters (n=14,HDRS≤7), responders (n=16,HDRS≥50%), low-responders (n=10,HDRS=30-49%), and non-responders (n=11,HDRS<30%). After registering images of postoperative to preoperative MRI and reconstructing electrode trajectories, volumes of tissue activated were estimated using Lead-DBS software. Each group's common WM activation map was generated using normative-connectome data and compared among four groups. Additionally, locations of active contacts were analyzed in MNI. We found significant but graded WM activation differences among four groups. Remitters shared full activation of the predefined three WM pathways. Responders also shared all critical pathways, but with fewer streamlines within CB and FM than remitters. Critically, low-responders show no activation of right CB, and non-responders miss activation of both right CB and FM. We also found inconsistent locations of left and right active contacts in low and non-responders. For low-responders, right active contacts were located more anterior compared to left. On the other hand, for non-responders, right contacts were located more inferiorly than left. These findings suggest that depression recovery with SCC-DBS is dependent on precision targeting of the requisite 3 bundles. Nonresponse is most influenced by the amount of CB stimulation with additional negative impact of incomplete FM stimulation. Consistent methods for tractography-guided surgical targeting are likely required for optimal SCC-DBS outcomes. Research Category and Technology and Methods Clinical Research: 1. Deep Brain Stimulation (DBS) Keywords: Deep Brain Stimulation, Subcallosal Cingulate, Treatment Resistant Depression
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".