gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Lateral habenular complex deep brain stimulation for refractory major depression – Presentation of two cases with off-stimulation relapses

Meeting Abstract

  • Martin Jakobs - Neurochirurgische Klinik, Sektion Stereotaktische Neurochirurgie, Universitätsklinikum Heidelberg
  • Alexander Sartorius - Abteilung für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit Mannheim
  • Andreas Unterberg - Neurochirurgische Klinik, Universitätsklinikum Heidelberg
  • Karl Kiening - Neurochirurgische Klinik, Sektion Stereotaktische Neurochirurgie, Universitätsklinikum Heidelberg

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 048

doi: 10.3205/13dgnc465, urn:nbn:de:0183-13dgnc4656

Published: May 21, 2013

© 2013 Jakobs et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Major depression (MD) is a common psychiatric disease with profound socio-economic and personal impact on quality of life. For severe cases of refractory MD concepts of deep brain stimulation (DBS) are evaluated for different targets. The Lateral Habenular complex (LHb-c) is an intricate target area that gears monoamine-producing brain stem nuclei closely involved in depressive pathology. LHb-c in depressive patients show volume reduction and hypermetabolism. Therefore our institutions chose the LHb-c as the target for bilateral DBS.

Method: Two female patients (n=2) underwent bilateral LHb-c DBS, initial inpatient and later outpatient psychiatric follow-up with documentation of Hamilton Depression Scale (HAMD21) and stimulation parameters. Patient 1 was treated for MD since the age of 18 had several suicide attempts (SA) and was on maintenance electroconvulsive therapy (mECT) for more than 2 years and underwent LHb-DBS at the age of 64. Patient 2 suffered from MD for more than 20 years refractory to medical treatment with several SAs and was receiving mECT for more than a year before undergoing LHb-DBS at the age of 68.

Results: Patient 1 had a peak HAMD21-score of 45 before undergoing DBS after 13 weeks of stimulation with 10.5 V, the patient reached full and stable remission with HAMD21-score of 3. After incidental off-stimulation after a bicycle accident at week 53 and pacer exhaustion at week 70 the patient had clinical relevant relapses with HAMD21-scores of 39 and 22. Full remission was achieved with full stimulation again after 12 and 15 weeks respectively. Patient 2 underwent LHb-DBS after a peak HAMD21-score of 30 and dropped to 11 after 9 weeks of stimulation with a maximum of 6V when device infection was noted and explantation was necessary. Off-Stimulation the patient demonstrated an immediate increase with a peak HAMD21 to 34 and attempted suicide. At week 17, the patient underwent successful re-implantation of the DBS-system and dropped afterwards to a HAMD21 of 15 under stimulation with 9V and is currently still improving. Patient one has undergone more than 80, patient 2 more than 30 weeks of follow-up so far.

Conclusions: In 2 cases of LHb-DBS for MD, full or partial remission was achieved after several weeks of stimulation. In both cases, off-stimulation led to severe and immediate clinical relapses. LHb-c is a promising target for DBS of severe refractory MD, needing more clinical experience and a clinical study at best.