Stereotactic Radiofrequency Ablation for Treatment-Refractory Depression: A Systematic Review and Meta-Analysis
(1) Background: Major depressive disorder (MDD) generates a large proportion of global disease burden. Stereotactic radiofrequency ablation (SRA) may be beneficial for selected patients with its most debilitating and refractory forms, but effect size is uncertain. (2) Methods: A systematic literatur...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-10-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/12/10/1379 |
| _version_ | 1797474744105172992 |
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| author | Pauline Sarah Münchenberg Eileen M. Joyce Keith Matthews David Christmas Ludvic Zrinzo |
| author_facet | Pauline Sarah Münchenberg Eileen M. Joyce Keith Matthews David Christmas Ludvic Zrinzo |
| author_sort | Pauline Sarah Münchenberg |
| collection | DOAJ |
| description | (1) Background: Major depressive disorder (MDD) generates a large proportion of global disease burden. Stereotactic radiofrequency ablation (SRA) may be beneficial for selected patients with its most debilitating and refractory forms, but effect size is uncertain. (2) Methods: A systematic literature review and meta-analysis on SRA for MDD was carried out. Patient-level data were extracted from articles reporting validated depression measures (Beck Depression Inventory (BDI), Montgomery–Åsberg Depression Rating Scale (MADRS)), pre- and at least six months post surgery. To accommodate different outcome measures, the standardised mean difference (SMD) between both scores was used as the principal effect size. Data were synthesised using a random-effects model. (3) Results: Five distinct studies were identified, comprising 116 patients (64 included in meta-analysis). Effect size comparing post- vs. pre-operative scores was 1.66 (CI 1.25–2.07). Anterior cingulotomy (two studies, <i>n =</i> 22) and anterior capsulotomy (three studies, <i>n</i> = 42) showed similar effect sizes: 1.51 (CI 0.82–2.20) vs. 1.74 (CI 1.23–2.26). Multiple procedures were performed in 30 of 116 (25.9%) patients. Based on patient-level data, 53% (<i>n</i> = 47) were responders (≥50% improvement), of which 34% reached remission (MADRS ≤ 10 or BDI ≤ 11). BDI mean improvement was 16.7 (44.0%) after a second procedure (<i>n</i> = 19). (4) Conclusions: The results are supportive of the benefit of SRA in selected patients with refractory MDD. |
| first_indexed | 2024-03-09T20:35:29Z |
| format | Article |
| id | doaj.art-eee66c4b84bd49058625f55fac7c9360 |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-09T20:35:29Z |
| publishDate | 2022-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-eee66c4b84bd49058625f55fac7c93602023-11-23T23:14:27ZengMDPI AGBrain Sciences2076-34252022-10-011210137910.3390/brainsci12101379Stereotactic Radiofrequency Ablation for Treatment-Refractory Depression: A Systematic Review and Meta-AnalysisPauline Sarah Münchenberg0Eileen M. Joyce1Keith Matthews2David Christmas3Ludvic Zrinzo4Department of Clinical & Motor Neurosciences, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UKDepartment of Clinical & Motor Neurosciences, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UKAdvanced Interventions Service, Ninewells Hospital and Medical School, Dundee DD1 9SY, UKAdvanced Interventions Service, Ninewells Hospital and Medical School, Dundee DD1 9SY, UKDepartment of Clinical & Motor Neurosciences, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK(1) Background: Major depressive disorder (MDD) generates a large proportion of global disease burden. Stereotactic radiofrequency ablation (SRA) may be beneficial for selected patients with its most debilitating and refractory forms, but effect size is uncertain. (2) Methods: A systematic literature review and meta-analysis on SRA for MDD was carried out. Patient-level data were extracted from articles reporting validated depression measures (Beck Depression Inventory (BDI), Montgomery–Åsberg Depression Rating Scale (MADRS)), pre- and at least six months post surgery. To accommodate different outcome measures, the standardised mean difference (SMD) between both scores was used as the principal effect size. Data were synthesised using a random-effects model. (3) Results: Five distinct studies were identified, comprising 116 patients (64 included in meta-analysis). Effect size comparing post- vs. pre-operative scores was 1.66 (CI 1.25–2.07). Anterior cingulotomy (two studies, <i>n =</i> 22) and anterior capsulotomy (three studies, <i>n</i> = 42) showed similar effect sizes: 1.51 (CI 0.82–2.20) vs. 1.74 (CI 1.23–2.26). Multiple procedures were performed in 30 of 116 (25.9%) patients. Based on patient-level data, 53% (<i>n</i> = 47) were responders (≥50% improvement), of which 34% reached remission (MADRS ≤ 10 or BDI ≤ 11). BDI mean improvement was 16.7 (44.0%) after a second procedure (<i>n</i> = 19). (4) Conclusions: The results are supportive of the benefit of SRA in selected patients with refractory MDD.https://www.mdpi.com/2076-3425/12/10/1379major depressive disorderstereotactic radiofrequency ablationtreatment-refractory depressionanterior cingulotomyanterior capsulotomy |
| spellingShingle | Pauline Sarah Münchenberg Eileen M. Joyce Keith Matthews David Christmas Ludvic Zrinzo Stereotactic Radiofrequency Ablation for Treatment-Refractory Depression: A Systematic Review and Meta-Analysis Brain Sciences major depressive disorder stereotactic radiofrequency ablation treatment-refractory depression anterior cingulotomy anterior capsulotomy |
| title | Stereotactic Radiofrequency Ablation for Treatment-Refractory Depression: A Systematic Review and Meta-Analysis |
| title_full | Stereotactic Radiofrequency Ablation for Treatment-Refractory Depression: A Systematic Review and Meta-Analysis |
| title_fullStr | Stereotactic Radiofrequency Ablation for Treatment-Refractory Depression: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Stereotactic Radiofrequency Ablation for Treatment-Refractory Depression: A Systematic Review and Meta-Analysis |
| title_short | Stereotactic Radiofrequency Ablation for Treatment-Refractory Depression: A Systematic Review and Meta-Analysis |
| title_sort | stereotactic radiofrequency ablation for treatment refractory depression a systematic review and meta analysis |
| topic | major depressive disorder stereotactic radiofrequency ablation treatment-refractory depression anterior cingulotomy anterior capsulotomy |
| url | https://www.mdpi.com/2076-3425/12/10/1379 |
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