A patient with a resistant major depression disorder treated with deep brain stimulation in the inferior thalamic peduncle.

摘要: Objective and importance The present report explored the effect of electrical stimulation on inferior thalamic peduncle in a patient with resistant major depression disorder (MDD). Clinical presentation This refers to 49-year-old woman history recurrent episodes for 20 years (12 2 hospitalizations), fulfilling Diagnostic Statistical Manual Mental Disorders, 4th edition, revised, criteria MDD; addition, met borderline personality bulimia. Her longest episode suicidal ideation began 5 before surgery. patient's symptom array responded poorly different combinations antidepressants, cognitive therapy, electroconvulsive which induced improvement only short periods time. Immediately surgery, her Global Assessment Functioning score was Hamilton Depression Scale ranged from 33 42. proposed surgery MDD. Intervention had bilateral eight-contact electrodes stereotactically implanted areas at around peduncle. Electrode position corroborated by unilateral searching recruiting responses regional direct current shifts electroencephalogram. Recording were replaced tetrapolar deep brain connected an internalized system continuous bipolar 130 Hz, 0.45 milliseconds, 2.5 V. Bimonthly follow-up included psychiatric neuropsychological evaluations performed over course 24 months. After 8 months ON stimulation, entered double-blind protocol stimulators turned OFF. Improvement measured evident after initial placement without stimulation. relapsed partially end first week. Electrical further improved depression, normalizing scores performance. Patient ranked between during antidepressant medication. OFF, spontaneous fluctuations symptoms reflected documented; these disappeared Month 20. Conclusion Complicated patients comorbid conditions are common referrals psychosurgery services. In this report, we promising results treat unipolar MDD who treatment.