Deep Brain Stimulation Successfully Treats Severely Depressive Patient

A team of neurosurgeons at Heidelberg University Hospital (Germany) and psychiatrists at the Central Institute of Mental Health (Mannheim, Germany) performed DBS by inserting electrodes into the habenulae, which were then connected with wires under the skin to an electronic impulse generator implanted in the chest. The electrodes emit current that continuously stimulate the nerve structure. The procedure was complex, as the target area is about half as large as other sites that are typically targeted for movement disorders, and in addition, is located in the middle of the brain, in the wall of what is known as the "third ventricle.” The success of the procedure was confirmed when the electrode was accidentally switched off; the patient had a bicycle accident which required surgery for which an ECG had to be made as preparation. The brain pacemaker was switched off and was not reactivated for a few days, and the depression promptly returned. A few weeks after reactivation, the patient completely recovered again. The concept of habenula stimulation and the case study were published in January 15, 2010, issue of the journal Biological Psychiatry.

"We decided to stimulate the habenula because it is involved is the control of three major neurotransmitter systems, which are known to be disturbed in depression,” said lead author psychiatrist Alexander Sartorius, M.D., of the Central Institute of Mental Health. "We aim to show that habenula stimulation has a better success rate than other target areas attempted for depression and that it is also safe to use.”

The neurosurgeons in Heidelberg and the psychiatrists in Mannheim now want to build on this positive experience and are planning a clinical study in which the habenula stimulation is to be implemented for severely depressive patients at five psychiatric-neurosurgery centers in Germany.

The habenula refers to a neighboring group of nerve cells with which the pineal gland was believed to be associated, the habenular nucleus. Currently, the term refers exclusively to this separate cell mass in the caudal and dorsal aspect of the dorsal thalamus (the epithalamus), embedded in the posterior end of the medullary stria from which it receives most of its afferent fibers.

Related Links:
Heidelberg University Hospital
Central Institute of Mental Health