Abstract #1183

Optimizing Subcallosal Cingulate DBS for Treatment Resistant Depression Based on Structural Connectivity

Ki Sueng Choi¹, Patricio Riva Posse², Paul E. Holtzheimer³, Cameron C. McIntyre⁴, Xiaoping P. Hu¹, Helen S. Mayberg²

¹BME, Georgia Institute of Technology / Emory University, Atlanta, GA, United States; ²Psychiatry, Emory University, Atlanta, GA, United States; ³Psychiatry and Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States; ⁴BME, Cleveland Clinic, Cleveland, OH, United States

Bilateral DBS of the subcallosal cingulate cortex results in sustained long-term antidepressant effects for treatment-resistant depression. Clinical response may be improved by more precise targeting along specific white matter tracts based on structural connectivity. The 6 and 24 months responder show connections to bilateral mF and limbic regions. The non-responder shows connections to unilateral mF but insufficient connections to limbic regions. For quantitative SC analysis, responder shows strong probability of connection to mF, bilateral inferior BA10, nucleus accumbens, putamen, and caudate. These results demonstrate that a successful clinical outcome is dependent on both bilateral mF and limbic/subcortical connections.