Benjamin Davidson, MD; Hrishikesh Suresh, MD; Maged Goubran, PhD; Jennifer S. Rabin, PhD; Ying Meng, MD; Karim Mithani, MEng; Christopher B. Pople, BSc; Peter Giacobbe, MD, MSc; Clement Hamani, MD, PhD; Nir Lipsman, MD, PhD
Background: Psychiatric surgery, including deep brain stimulation and stereotactic ablation, is an important treatment option in severe refractory psychiatric illness. Several large trials have demonstrated response rates of approximately 50%, underscoring the need to identify and select responders preoperatively. Recent advances in neuroimaging have brought this possibility into focus. We systematically reviewed the psychiatric surgery neuroimaging literature to assess the current state of evidence for preoperative imaging predictors of response.
Methods: We performed this study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) frameworks, and preregistered it using PROSPERO. We systematically searched the Medline, Embase and Cochrane databases for studies reporting preoperative neuroimaging analyses correlated with clinical outcomes in patients who underwent psychiatric surgery. We recorded and synthesized the methodological details, imaging results and clinical correlations from these studies.
Results: After removing duplicates, the search yielded 8388 unique articles, of which 7 met the inclusion criteria. The included articles were published between 2001 and 2018 and reported on the outcomes of 101 unique patients. Of the 6 studies that reported significant findings, all identified clusters of hypermetabolism, hyperconnectivity or increased size in the frontostriatal limbic circuitry.
Limitations: The included studies were few and highly varied, spanning 2 decades.
Conclusion: Although few studies have analyzed preoperative imaging for predictors of response to psychiatric surgery, we found consistency among the reported results: most studies implicated overactivity in the frontostriatal limbic network as being correlated with clinical response. Larger prospective studies are needed.
Submitted Dec. 9, 2019; Revised Jan. 23, 2020; Accepted Jan. 23, 2020; Published online Apr. 15, 2020
Affiliations: From the Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont., Canada (Davidson, Suresh, Hamani, Lipsman); and the Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ont., Canada (Davidson, Goubran, Rabin, Meng, Mithani, Pople, Giacobbe, Hamani, Lipsman).
Competing interests: P. Giacobbe declares grants/research support: from CIHR, NARSAD, NIH and Veteran’s Affairs Canada; and honoraria and/or speaker fees from AstraZeneca, BMS, Pfizer, Eli Lilly and St. Jude Medical. No other competing interests were declared.
Contributors: B. Davidson, M. Goubran, K. Mithani, C. Pople, C. Hamani and N. Lipsman designed the study. B. Davidson, H. Suresh, and K. Mithani acquired the data, which B. Davidson, H. Suresh, M. Goubran, J. Rabin, Y. Meng, C. Pople, P. Giacobbe and N. Lipsman analyzed, B. Davidson, J. Rabin, M. Goubran and N. Lipsman wrote the article, which all authors reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.
Correspondence to: N. Lipsman, 2075 Bayview Ave., Room A1-39, Toronto, ON M4N 3M5; email@example.com