{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:44:57Z","timestamp":1791999897640,"version":"4.4.0"},"reference-count":93,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T00:00:00Z","timestamp":1627516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"RR Tasker Chair in Functional Neurosurgery at University Health Network (A.M.L.) and the Canadian Institutes of Health Research","award":["# 164235: G.J.B.E."],"award-info":[{"award-number":["# 164235: G.J.B.E."]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,3,29]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Subcallosal cingulate deep brain stimulation produces long-term clinical improvement in approximately half of patients with severe treatment-resistant depression. We hypothesized that both structural and functional brain attributes may be important in determining responsiveness to this therapy.<\/jats:p><jats:p>In a treatment-resistant depression subcallosal cingulate deep brain stimulation cohort, we retrospectively examined baseline and longitudinal differences in MRI-derived brain volume (n = 65) and 18F-fluorodeoxyglucose-PET glucose metabolism (n = 21) between responders and non-responders. Support vector machines were subsequently trained to classify patients\u2019 response status based on extracted baseline imaging features. A machine learning model incorporating preoperative frontopolar, precentral\/frontal opercular and orbitofrontal local volume values classified binary response status (12 months) with 83% accuracy [leave-one-out cross-validation (LOOCV): 80% accuracy] and explained 32% of the variance in continuous clinical improvement. It was also predictive in an out-of-sample subcallosal cingulate deep brain stimulation cohort (n = 21) with differing primary indications (bipolar disorder\/anorexia nervosa; 76% accuracy). Adding preoperative glucose metabolism information from rostral anterior cingulate cortex and temporal pole improved model performance, enabling it to predict response status in the treatment-resistant depression cohort with 86% accuracy (LOOCV: 81% accuracy) and explain 67% of clinical variance. Response-related patterns of metabolic and structural post-deep brain stimulation change were also observed, especially in anterior cingulate cortex and neighbouring white matter. Areas where responders differed from non-responders\u2014both at baseline and longitudinally\u2014largely overlapped with depression-implicated white matter tracts, namely uncinate fasciculus, cingulum bundle and forceps minor\/rostrum of corpus callosum. The extent of patient-specific engagement of these same tracts (according to electrode location and stimulation parameters) also served as an independent predictor of treatment-resistant depression response status (72% accuracy; LOOCV: 70% accuracy) and augmented performance of the volume-based (88% accuracy; LOOCV: 82% accuracy) and combined volume\/metabolism-based support vector machines (100% accuracy; LOOCV: 94% accuracy).<\/jats:p><jats:p>Taken together, these results indicate that responders and non-responders to subcallosal cingulate deep brain stimulation exhibit differences in brain volume and metabolism, both pre- and post-surgery. Moreover, baseline imaging features predict response to treatment (particularly when combined with information about local tract engagement) and could inform future patient selection and other clinical decisions.<\/jats:p>","DOI":"10.1093\/brain\/awab284","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T19:13:23Z","timestamp":1627499603000},"page":"362-377","source":"Crossref","is-referenced-by-count":45,"title":["Structuro-functional surrogates of response to subcallosal cingulate deep brain stimulation for depression"],"prefix":"10.1093","volume":"145","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7495-550X","authenticated-orcid":false,"given":"Gavin J B","family":"Elias","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto M5T 2S8, Canada"},{"name":"Krembil Research Institute, University of Toronto, Toronto M5T 0S8, 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