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Deep brain stimulation and treatment-resistant obsessive-compulsive disorder: A systematic review. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2017; 12:37-51. [PMID: 28676437 DOI: 10.1016/j.rpsm.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 04/05/2017] [Accepted: 05/15/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION At least 10% of patients with Obsessive-compulsive Disorder (OCD) are refractory to psychopharmacological treatment. The emergence of new technologies for the modulation of altered neuronal activity in Neurosurgery, deep brain stimulation (DBS), has enabled its use in severe and refractory OCD cases. The objective of this article is to review the current scientific evidence on the effectiveness and applicability of this technique to refractory OCD. METHOD We systematically reviewed the literature to identify the main characteristics of deep brain stimulation, its use and applicability as treatment for obsessive-compulsive disorder. Therefore, we reviewed PubMed/Medline, Embase and PsycINFO databases, combining the key-words 'Deep brain stimulation', 'DBS' and 'Obsessive-compulsive disorder' 'OCS'. The articles were selected by two of the authors independently, based on the abstracts, and if they described any of the main characteristics of the therapy referring to OCD: applicability; mechanism of action; brain therapeutic targets; efficacy; side-effects; co-therapies. All the information was subsequently extracted and analysed. RESULTS The critical analysis of the evidence shows that the use of DBS in treatment-resistant OCD is providing satisfactory results regarding efficacy, with assumable side-effects. However, there is insufficient evidence to support the use of any single brain target over another. Patient selection has to be done following analyses of risks/benefits, being advisable to individualize the decision of continuing with concomitant psychopharmacological and psychological treatments. CONCLUSIONS The use of DBS is still considered to be in the field of research, although it is increasingly used in refractory-OCD, producing in the majority of studies significant improvements in symptomatology, and in functionality and quality of life. It is essential to implement random and controlled studies regarding its long-term efficacy, cost-risk analyses and cost/benefit.
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Raymaekers S, Vansteelandt K, Luyten L, Bervoets C, Demyttenaere K, Gabriëls L, Nuttin B. Long-term electrical stimulation of bed nucleus of stria terminalis for obsessive-compulsive disorder. Mol Psychiatry 2017; 22:931-934. [PMID: 27480493 DOI: 10.1038/mp.2016.124] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/15/2016] [Accepted: 06/17/2016] [Indexed: 12/21/2022]
Abstract
We previously reported that bilateral electrical stimulation in the anterior limb of the internal capsule/bed nucleus of the stria terminalis (IC/BST) effectively reduces symptoms in severe treatment-resistant obsessive-compulsive disorder (OCD) patients. Here we used a linear mixed model to investigate the evolution of symptomatic and functional status of our patients (n=24) and examined if baseline variables could predict this evolution. Data were collected during routine, clinical psychiatric visits. Our analysis showed a long-term, sustained effect of electrical stimulation in the IC/BST. After a fast initial decline of OCD symptoms, these symptoms remain relatively stable. In addition, we found a strong ON/OFF effect of stimulation (e.g., due to battery depletion). Our data also show that it is not the surgical procedure but rather the electrical stimulation that drives the improvement in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores. The Beck Depression Inventory (BDI) at baseline was the only predictor significantly related to the evolution of the Y-BOCS. A higher BDI at baseline seemed to be related to a smaller decrease of the Y-BOCS over time. In conclusion, electrical stimulation in the IC/BST has a fast and sustained effect on OCD and comorbid symptoms and functional status of patients.
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Affiliation(s)
- S Raymaekers
- KU Leuven Research Group Psychiatry, Leuven, Belgium.,Z.ORG UPC KU Leuven, Leuven, Belgium
| | - K Vansteelandt
- KU Leuven Research Group Psychiatry, Leuven, Belgium.,Z.ORG UPC KU Leuven, Leuven, Belgium
| | - L Luyten
- KU Leuven Research Group Psychology of Learning and Experimental Psychopathology, Leuven, Belgium.,KU Leuven Research Group Experimental Neurosurgery and Neuroanatomy, Leuven, Belgium
| | | | - K Demyttenaere
- KU Leuven Research Group Psychiatry, Leuven, Belgium.,Z.ORG UPC KU Leuven, Leuven, Belgium
| | | | - B Nuttin
- KU Leuven Research Group Experimental Neurosurgery and Neuroanatomy, Leuven, Belgium.,UZ Leuven Department of Neurosurgery, Leuven, Belgium
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Choreatic Side Effects of Deep Brain Stimulation of the Anteromedial Subthalamic Nucleus for Treatment-Resistant Obsessive-Compulsive disorder. World Neurosurg 2017; 104:1048.e9-1048.e13. [PMID: 28532905 DOI: 10.1016/j.wneu.2017.05.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with treatment-resistant obsessive-compulsive disorder (OCD) are potential candidates for deep brain stimulation (DBS). The anteromedial subthalamic nucleus (STN) is among the most commonly used targets for DBS in OCD. CASE DESCRIPTION We present a patient with a 30-year history of treatment-resistant OCD who underwent anteromedial STN-DBS. Despite a clear mood-enhancing effect, stimulation caused motor side effects, including bilateral hyperkinesia, dyskinesias, and sudden large amplitude choreatic movements of arms and legs when stimulating at voltages greater than approximately 1.5 V. DBS at lower amplitudes and at other contact points failed to result in a significant reduction of obsessions and compulsions without inducing motor side effects. Because of this limitation in programming options, we decided to reoperate and target the ventral capsule/ventral striatum (VC/VS), which resulted in a substantial reduction in key obsessive and compulsive symptoms without serious side effects. CONCLUSIONS Choreatic movements and hemiballismus have previously been linked to STN dysfunction and have been incidentally reported as side effects of DBS of the dorsolateral STN in Parkinson disease (PD). However, in PD, these side effects were usually transient, and they rarely interfered with DBS programming. In our patient, the motor side effects were persistent, and they made optimal DBS programming impossible. To our knowledge, such severe and persistent motor side effects have not been described previously for anteromedial STN-DBS.
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Roy HA, Green AL, Aziz TZ. State of the Art: Novel Applications for Deep Brain Stimulation. Neuromodulation 2017; 21:126-134. [DOI: 10.1111/ner.12604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/19/2017] [Accepted: 03/11/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Holly A. Roy
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
| | - Alexander L. Green
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
| | - Tipu Z. Aziz
- Nuffield Department of Surgical Sciences; Oxford University; Oxford UK
- Neurosurgery Department; Oxford University Hospitals; Oxford UK
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55
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Gibson WS, Cho S, Abulseoud OA, Gorny KR, Felmlee JP, Welker KM, Klassen BT, Min HK, Lee KH. The Impact of Mirth-Inducing Ventral Striatal Deep Brain Stimulation on Functional and Effective Connectivity. Cereb Cortex 2017; 27:2183-2194. [PMID: 27001680 DOI: 10.1093/cercor/bhw074] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) is an investigational therapy for treatment-resistant obsessive-compulsive disorder. The ability of VC/VS DBS to evoke spontaneous mirth in patients, often accompanied by smiling and laughter, is clinically well documented. However, the neural correlates of DBS-evoked mirth remain poorly characterized. Patients undergoing VC/VS DBS surgery underwent intraoperative evaluation in which mirth-inducing and non-mirth-inducing stimulation localizations were identified. Using dynamic causal modeling (DCM) for fMRI, the effect of mirth-inducing DBS on functional and effective connectivity among established nodes in limbic cortico-striato-thalamo-cortical (CSTC) circuitry was investigated. Both mirth-inducing and non-mirth-inducing VC/VS DBS consistently resulted (conjunction, global null, family-wise error-corrected P < 0.05) in activation of amygdala, ventral striatum, and mediodorsal thalamus. However, only mirth-inducing DBS resulted in functional inhibition of anterior cingulate cortex. Dynamic causal modeling revealed that mirth-inducing DBS enhanced effective connectivity from anterior cingulate to ventral striatum, while attenuating connectivity from thalamus to ventral striatum relative to non-mirth-inducing stimulation. These results suggest that DBS-evoked mood elevation is accompanied by distinct patterns of limbic thalamocortical connectivity. Using the novel combination of DBS-evoked mood alteration and functional MRI in human subjects, we provide new insights into the network-level mechanisms that influence affect.
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Affiliation(s)
| | | | - Osama A Abulseoud
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55906, USA.,National Institute on Drug Abuse, Baltimore, MD 21224, USA
| | | | | | | | | | - Hoon-Ki Min
- Department of Neurologic Surgery.,Department of Radiology.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, US.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
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56
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Choudhury TK, Davidson JE, Viswanathan A, Strutt AM. Deep brain stimulation of the anterior limb of the internal capsule for treatment of therapy-refractory obsessive compulsive disorder (OCD): a case study highlighting neurocognitive and psychiatric changes. Neurocase 2017; 23:138-145. [PMID: 28457185 DOI: 10.1080/13554794.2017.1319958] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Obsessive compulsive disorder (OCD) is an anxiety disorder characterized by repeated, unwanted thoughts and behaviors. Individuals with this condition often experience significant emotional distress secondary to their symptoms. Additionally, impairments in attention/concentration, processing speed, and executive functions are typically observed. The exact pathology of OCD remains unknown; consequently, it can be difficult to treat patients with severe symptomatology. Deep brain stimulation (DBS) may be a viable treatment option for individuals who do not respond to medication and/or cognitive behavioral therapy. The following case discusses DBS of the anterior limb of the internal capsule for a patient with severe, therapy-refractory OCD, including pre- to postoperative neurocognitive and psychiatric changes.
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Affiliation(s)
- Tabina K Choudhury
- a Department of Psychology , Texas A&M University , College Station , TX , USA.,b Department of Neurology , Baylor College of Medicine , Houston , TX , USA
| | - Joyce E Davidson
- c Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA
| | - Ashwin Viswanathan
- d Department of Neurosurgery , Baylor College of Medicine , Houston , TX , USA
| | - Adriana M Strutt
- b Department of Neurology , Baylor College of Medicine , Houston , TX , USA.,c Department of Psychiatry and Behavioral Sciences , Baylor College of Medicine , Houston , TX , USA
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57
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Schippers MC, Bruinsma B, Gaastra M, Mesman TI, Denys D, De Vries TJ, Pattij T. Deep Brain Stimulation of the Nucleus Accumbens Core Affects Trait Impulsivity in a Baseline-Dependent Manner. Front Behav Neurosci 2017; 11:52. [PMID: 28386221 PMCID: PMC5362621 DOI: 10.3389/fnbeh.2017.00052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/07/2017] [Indexed: 12/29/2022] Open
Abstract
Deep brain stimulation (DBS) of the nucleus accumbens (NA) is explored as a treatment for refractory psychiatric disorders, such as obsessive-compulsive disorder (OCD), depressive disorder (MDD), and substance use disorder (SUD). A common feature of some of these disorders is pathological impulsivity. Here, the effects of NAcore DBS on impulsive choice and impulsive action, two distinct forms of impulsive behavior, were investigated in translational animal tasks, the delayed reward task (DRT) and five-choice serial reaction time task (5-CSRTT), respectively. In both tasks, the effects of NAcore DBS were negatively correlated with baseline impulsive behavior, with more pronounced effects in the 5-CSRTT. To further examine the effects of DBS on trait impulsive action, rats were screened for high (HI) and low (LI) impulsive responding in the 5-CSRTT. NAcore DBS decreased impulsive, premature responding in HI rats under conventional conditions. However, upon challenged conditions to increase impulsive responding, NAcore DBS did not alter impulsivity. These results strongly suggest a baseline-dependent effect of DBS on impulsivity, which is in line with clinical observations.
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Affiliation(s)
- Maria C Schippers
- Amsterdam Neuroscience, Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, Netherlands
| | - Bastiaan Bruinsma
- Amsterdam Neuroscience, Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, Netherlands
| | - Mathijs Gaastra
- Amsterdam Neuroscience, Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, Netherlands
| | - Tanja I Mesman
- Amsterdam Neuroscience, Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, Netherlands
| | - Damiaan Denys
- Amsterdam Neuroscience, Department of Psychiatry, Academic Medical Center, University of Amsterdam Amsterdam, Netherlands
| | - Taco J De Vries
- Amsterdam Neuroscience, Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, Netherlands
| | - Tommy Pattij
- Amsterdam Neuroscience, Department of Anatomy and Neurosciences, VU University Medical Center Amsterdam, Netherlands
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Cagnan H, Pedrosa D, Little S, Pogosyan A, Cheeran B, Aziz T, Green A, Fitzgerald J, Foltynie T, Limousin P, Zrinzo L, Hariz M, Friston KJ, Denison T, Brown P. Stimulating at the right time: phase-specific deep brain stimulation. Brain 2017; 140:132-145. [PMID: 28007997 PMCID: PMC5226063 DOI: 10.1093/brain/aww286] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 08/30/2016] [Accepted: 09/18/2016] [Indexed: 11/13/2022] Open
Abstract
SEE MOLL AND ENGEL DOI101093/AWW308 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: Brain regions dynamically engage and disengage with one another to execute everyday actions from movement to decision making. Pathologies such as Parkinson's disease and tremor emerge when brain regions controlling movement cannot readily decouple, compromising motor function. Here, we propose a novel stimulation strategy that selectively regulates neural synchrony through phase-specific stimulation. We demonstrate for the first time the therapeutic potential of such a stimulation strategy for the treatment of patients with pathological tremor. Symptom suppression is achieved by delivering stimulation to the ventrolateral thalamus, timed according to the patient's tremor rhythm. Sustained locking of deep brain stimulation to a particular phase of tremor afforded clinically significant tremor relief (up to 87% tremor suppression) in selected patients with essential tremor despite delivering less than half the energy of conventional high frequency stimulation. Phase-specific stimulation efficacy depended on the resonant characteristics of the underlying tremor network. Selective regulation of neural synchrony through phase-locked stimulation has the potential to both increase the efficiency of therapy and to minimize stimulation-induced side effects.
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Affiliation(s)
- Hayriye Cagnan
- 1 Institute of Neurology, University College London, London, UK
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- 3 Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - David Pedrosa
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- 3 Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Simon Little
- 1 Institute of Neurology, University College London, London, UK
| | - Alek Pogosyan
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- 3 Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Binith Cheeran
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Tipu Aziz
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alexander Green
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - James Fitzgerald
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas Foltynie
- 1 Institute of Neurology, University College London, London, UK
| | | | - Ludvic Zrinzo
- 1 Institute of Neurology, University College London, London, UK
| | - Marwan Hariz
- 1 Institute of Neurology, University College London, London, UK
| | - Karl J Friston
- 1 Institute of Neurology, University College London, London, UK
| | | | - Peter Brown
- 2 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- 3 Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
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59
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Woon LSC, Kanapathy A, Zakaria H, Alfonso CA. An Integrative Approach to Treatment-Resistant Obsessive-Compulsive Disorder. Psychodyn Psychiatry 2017; 45:237-257. [PMID: 28590207 DOI: 10.1521/pdps.2017.45.2.237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that often runs a chronic unremitting course. Treatment outcomes can be unsatisfactory despite the availability of various somatic and psychological therapies. Psychodynamic psychotherapy in combination with cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) could help patients with treatment-resistant OCD achieve better outcomes. An integrative approach can help patients gain insight, strengthen the therapeutic alliance, improve treatment adherence, and provide symptomatic relief when other treatments seem insufficient or have failed. We describe the treatment process of a person with treatment-resistant OCD who received pharmacotherapy, concurrent CBT/ERP, and a brief course of psychodynamic psychotherapy. Case formulations from cognitive behavioral and psychodynamic perspectives are presented. The authors discuss the advantages of doing a psychodynamic assessment and formulation in treatment refractory cases and the wisdom of integrating psychotherapy interventions for OCD, as well as the unique clinical features of cases that warrant a multimodal treatment approach.
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Affiliation(s)
- Luke Sy-Cherng Woon
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Anita Kanapathy
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Hazli Zakaria
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - César A Alfonso
- Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
- Columbia University Medical Center Department of Psychiatry, New York
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60
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Neumaier F, Paterno M, Alpdogan S, Tevoufouet EE, Schneider T, Hescheler J, Albanna W. Surgical Approaches in Psychiatry: A Survey of the World Literature on Psychosurgery. World Neurosurg 2017; 97:603-634.e8. [DOI: 10.1016/j.wneu.2016.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 12/11/2022]
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61
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Mulders AEP, Plantinga BR, Schruers K, Duits A, Janssen MLF, Ackermans L, Leentjens AFG, Jahanshahi A, Temel Y. Deep brain stimulation of the subthalamic nucleus in obsessive-compulsive disorder: Neuroanatomical and pathophysiological considerations. Eur Neuropsychopharmacol 2016; 26:1909-1919. [PMID: 27838106 DOI: 10.1016/j.euroneuro.2016.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 07/04/2016] [Accepted: 10/29/2016] [Indexed: 11/17/2022]
Abstract
Obsessive-compulsive disorder (OCD) is among the most disabling chronic psychiatric disorders and has a significant negative impact on multiple domains of quality of life. For patients suffering from severe refractory OCD, deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been applied. Reviewing the literature of the last years we believe that through its central position within the cortico-basal ganglia-thalamocortical circuits, the STN has a coordinating role in decision-making and action-selection mechanisms. Dysfunctional information-processing at the level of the STN is responsible for some of the core symptoms of OCD. Research confirms an electrophysiological dysfunction in the associative and limbic (non-motor) parts of the STN. Compared to Parkinson׳s disease patients, STN neurons in OCD exhibit a lower firing rate, less frequent but longer bursts, increased burst activity in the anterior ventromedial area, an asymmetrical left-sided burst distribution, and a predominant oscillatory activity in the δ-band. Moreover, there is direct evidence for the involvement of the STN in both checking behavior and OCD symptoms, which are both related to changes in electrophysiological activity in the non-motor STN. Through a combination of mechanisms, DBS of the STN seems to interrupt the disturbed information-processing, leading to a normalization of connectivity within the cortico-basal ganglia-thalamocortical circuits and consequently to a reduction in symptoms. In conclusion, based on the STN׳s strategic position within cortico-basal ganglia-thalamocortical circuits and its involvement in action-selection mechanisms that are responsible for some of the core symptoms of OCD, the STN is a mechanism-based target for DBS in OCD.
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Affiliation(s)
- A E P Mulders
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - B R Plantinga
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Biomedical Image Analysis, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - K Schruers
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Duits
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M L F Janssen
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L Ackermans
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A F G Leentjens
- Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Jahanshahi
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Y Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
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62
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Kar SK, Sarkar S. Neuro-stimulation Techniques for the Management of Anxiety Disorders: An Update. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2016; 14:330-337. [PMID: 27776384 PMCID: PMC5083940 DOI: 10.9758/cpn.2016.14.4.330] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/30/2016] [Accepted: 06/08/2016] [Indexed: 12/23/2022]
Abstract
Neuro-stimulation techniques have gradually evolved over the decades and have emerged potential therapeutic modalities for the treatment of psychiatric disorders, especially treatment refractory cases. The neuro-stimulation techniques involves modalities like electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS) and others. This review discusses the role of neuro-stimulation techniques in the treatment of anxiety disorders. The various modalities of neuro-stimulation techniques are briefly discussed. The evidence base relating to use of these techniques in the treatment of anxiety disorders is discussed further. The review then highlights the challenges in conducting research in relation to the use of neuro-stimulation techniques with reference to patients with anxiety disorders. The review provides the future directions of research and aimed at expanding the evidence base of treatment of anxiety disorders and providing neuro-stimulation techniques as promising effective and acceptable alternative in select cases.
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Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, India
| | - Siddharth Sarkar
- Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
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Stuchlik A, Radostová D, Hatalova H, Vales K, Nekovarova T, Koprivova J, Svoboda J, Horacek J. Validity of Quinpirole Sensitization Rat Model of OCD: Linking Evidence from Animal and Clinical Studies. Front Behav Neurosci 2016; 10:209. [PMID: 27833539 PMCID: PMC5080285 DOI: 10.3389/fnbeh.2016.00209] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/17/2016] [Indexed: 11/15/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder with 1–3% prevalence. OCD is characterized by recurrent thoughts (obsessions) and repetitive behaviors (compulsions). The pathophysiology of OCD remains unclear, stressing the importance of pre-clinical studies. The aim of this article is to critically review a proposed animal model of OCD that is characterized by the induction of compulsive checking and behavioral sensitization to the D2/D3 dopamine agonist quinpirole. Changes in this model have been reported at the level of brain structures, neurotransmitter systems and other neurophysiological aspects. In this review, we consider these alterations in relation to the clinical manifestations in OCD, with the aim to discuss and evaluate axes of validity of this model. Our analysis shows that some axes of validity of quinpirole sensitization model (QSM) are strongly supported by clinical findings, such as behavioral phenomenology or roles of brain structures. Evidence on predictive validity is contradictory and ambiguous. It is concluded that this model is useful in the context of searching for the underlying pathophysiological basis of the disorder because of the relatively strong biological similarities with OCD.
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Affiliation(s)
- Ales Stuchlik
- Department of Neurophysiology of Memory, Institute of Physiology, Czech Academy of Sciences Prague, Czech Republic
| | - Dominika Radostová
- Department of Neurophysiology of Memory, Institute of Physiology, Czech Academy of Sciences Prague, Czech Republic
| | - Hana Hatalova
- Department of Neurophysiology of Memory, Institute of Physiology, Czech Academy of Sciences Prague, Czech Republic
| | - Karel Vales
- Department of Neurophysiology of Memory, Institute of Physiology, Czech Academy of SciencesPrague, Czech Republic; National Institute of Mental HealthKlecany, Czech Republic
| | - Tereza Nekovarova
- Department of Neurophysiology of Memory, Institute of Physiology, Czech Academy of SciencesPrague, Czech Republic; National Institute of Mental HealthKlecany, Czech Republic
| | - Jana Koprivova
- National Institute of Mental Health Klecany, Czech Republic
| | - Jan Svoboda
- Department of Neurophysiology of Memory, Institute of Physiology, Czech Academy of Sciences Prague, Czech Republic
| | - Jiri Horacek
- National Institute of Mental Health Klecany, Czech Republic
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65
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Kohl S, Baldermann JC, Denys D, Kuhn J. A Synergistic Treatment Strategy for Severe Obsessive Compulsive Disorder. Neuromodulation 2016; 19:542-4. [DOI: 10.1111/ner.12461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sina Kohl
- Department of Psychiatry and Psychotherapy; University of Cologne; Cologne Germany
| | | | - Damiaan Denys
- Department of Psychiatry; Academic Medical Center; Amsterdam The Netherlands
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy; University of Cologne; Cologne Germany
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66
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Mahmud M, Vassanelli S. Differential Modulation of Excitatory and Inhibitory Neurons during Periodic Stimulation. Front Neurosci 2016; 10:62. [PMID: 26941602 PMCID: PMC4766297 DOI: 10.3389/fnins.2016.00062] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/09/2016] [Indexed: 01/02/2023] Open
Abstract
Non-invasive transcranial neuronal stimulation, in addition to deep brain stimulation, is seen as a promising therapeutic and diagnostic approach for an increasing number of neurological diseases such as epilepsy, cluster headaches, depression, specific type of blindness, and other central nervous system disfunctions. Improving its effectiveness and widening its range of use may strongly rely on development of proper stimulation protocols that are tailored to specific brain circuits and that are based on a deep knowledge of different neuron types response to stimulation. To this aim, we have performed a simulation study on the behavior of excitatory and inhibitory neurons subject to sinusoidal stimulation. Due to the intrinsic difference in membrane conductance properties of excitatory and inhibitory neurons, we show that their firing is differentially modulated by the wave parameters. We analyzed the behavior of the two neuronal types for a broad range of stimulus frequency and amplitude and demonstrated that, within a small-world network prototype, parameters tuning allow for a selective enhancement or suppression of the excitation/inhibition ratio.
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Affiliation(s)
- Mufti Mahmud
- NeuroChip Laboratory, Department of Biomedical Sciences, University of PadovaPadova, Italy; Institute of Information Technology, Jahangirnagar UniversitySavar, Dhaka, Bangladesh
| | - Stefano Vassanelli
- NeuroChip Laboratory, Department of Biomedical Sciences, University of Padova Padova, Italy
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A step forward in elucidating the mystery of OCD. Eur Arch Psychiatry Clin Neurosci 2015; 265:735-6. [PMID: 25708456 DOI: 10.1007/s00406-015-0584-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/08/2015] [Indexed: 10/24/2022]
Abstract
Obsessive-compulsive disorder represents one of the most disabling psychiatric disorders. The underlying pathophysiology is not fully understood. In a recent Science article, Ahmari and colleagues enlighten fundamental aspects of obsessive-compulsive disorder by means of optogenetic stimulation, thereby also elucidating the usefulness of SSRI in the treatment for OCD.
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68
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Venkiteswaran K, Alexander DN, Puhl MD, Rao A, Piquet AL, Nyland JE, Subramanian MP, Iyer P, Boisvert MM, Handly E, Subramanian T, Grigson PS. Transplantation of human retinal pigment epithelial cells in the nucleus accumbens of cocaine self-administering rats provides protection from seeking. Brain Res Bull 2015; 123:53-60. [PMID: 26562520 DOI: 10.1016/j.brainresbull.2015.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/30/2015] [Accepted: 11/05/2015] [Indexed: 01/05/2023]
Abstract
Chronic exposure to drugs and alcohol leads to damage to dopaminergic neurons and their projections in the 'reward pathway' that originate in the ventral tegmental area (VTA) and terminate in the nucleus accumbens (NAc). This damage is thought to contribute to the signature symptom of addiction: chronic relapse. In this study we show that bilateral transplants of human retinal pigment epithelial cells (RPECs), a cell mediated dopaminergic and trophic neuromodulator, into the medial shell of the NAc, rescue rats with a history of high rates of cocaine self-administration from drug-seeking when returned, after 2 weeks of abstinence, to the drug-associated chamber under extinction conditions (i.e., with no drug available). Excellent survival was noted for the transplant of RPECs in the shell and/or the core of the NAc bilaterally in all rats that showed behavioral recovery from cocaine seeking. Design based unbiased stereology of tyrosine hydroxylase (TH) positive cell bodies in the VTA showed better preservation (p<0.035) in transplanted animals compared to control animals. This experiment shows that the RPEC graft provides beneficial effects to prevent drug seeking in drug addiction via its effects directly on the NAc and its neural network with the VTA.
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Affiliation(s)
- Kala Venkiteswaran
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA; Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Danielle N Alexander
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Matthew D Puhl
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Anand Rao
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Amanda L Piquet
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Jennifer E Nyland
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Megha P Subramanian
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA; Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Puja Iyer
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Matthew M Boisvert
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Erin Handly
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA; Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Thyagarajan Subramanian
- Department of Neurology, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA; Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
| | - Patricia Sue Grigson
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, 500 University Drive, Hershey, PA 17033, USA.
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Kohl S, Gruendler TOJ, Huys D, Sildatke E, Dembek TA, Hellmich M, Vorderwulbecke M, Timmermann L, Ahmari SE, Klosterkoetter J, Jessen F, Sturm V, Visser-Vandewalle V, Kuhn J. Effects of deep brain stimulation on prepulse inhibition in obsessive-compulsive disorder. Transl Psychiatry 2015; 5:e675. [PMID: 26556284 PMCID: PMC5068764 DOI: 10.1038/tp.2015.171] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/14/2015] [Accepted: 09/19/2015] [Indexed: 11/09/2022] Open
Abstract
Owing to a high response rate, deep brain stimulation (DBS) of the ventral striatal area has been approved for treatment-refractory obsessive-compulsive disorder (tr-OCD). Many basic issues regarding DBS for tr-OCD are still not understood, in particular, the mechanisms of action and the origin of side effects. We measured prepulse inhibition (PPI) in treatment-refractory OCD patients undergoing DBS of the nucleus accumbens (NAcc) and matched controls. As PPI has been used in animal DBS studies, it is highly suitable for translational research. Eight patients receiving DBS, eight patients with pharmacological treatment and eight age-matched healthy controls participated in our study. PPI was measured twice in the DBS group: one session with the stimulator switched on and one session with the stimulator switched off. OCD patients in the pharmacologic group took part in a single session. Controls were tested twice, to ensure stability of data. Statistical analysis revealed significant differences between controls and (1) patients with pharmacological treatment and (2) OCD DBS patients when the stimulation was switched off. Switching the stimulator on led to an increase in PPI at a stimulus-onset asynchrony of 200 ms. There was no significant difference in PPI between OCD patients being stimulated and the control group. This study shows that NAcc-DBS leads to an increase in PPI in tr-OCD patients towards a level seen in healthy controls. Assuming that PPI impairments partially reflect the neurobiological substrates of OCD, our results show that DBS of the NAcc may improve sensorimotor gating via correction of dysfunctional neural substrates. Bearing in mind that PPI is based on a complex and multilayered network, our data confirm that DBS most likely takes effect via network modulation.
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Affiliation(s)
- S Kohl
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, University of Cologne, Cologne, Germany,Department of Psychiatry and Psychotherapy, University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50935 Cologne, Germany. E-mail:
| | - T O J Gruendler
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, University of Cologne, Cologne, Germany,Faculty of Economics, Otto-von-Guericke-University, Magdeburg, Germany,Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - D Huys
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - E Sildatke
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - T A Dembek
- Department of Neurology, University of Cologne, Cologne, Germany
| | - M Hellmich
- Institute of Medical Statistics, Informatics, and Epidemiology, University of Cologne, Cologne, Germany
| | - M Vorderwulbecke
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - L Timmermann
- Department of Neurology, University of Cologne, Cologne, Germany
| | - S E Ahmari
- Department of Psychiatry, Center for Neuroscience Program, Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Klosterkoetter
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - F Jessen
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - V Sturm
- Department of Neurosurgery, University of Würzburg, Würzburg, Germany
| | - V Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany
| | - J Kuhn
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, University of Cologne, Cologne, Germany
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Fluri F, Bieber M, Volkmann J, Kleinschnitz C. Microelectrode Guided Implantation of Electrodes into the Subthalamic Nucleus of Rats for Long-term Deep Brain Stimulation. J Vis Exp 2015. [PMID: 26485522 DOI: 10.3791/53066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Deep brain stimulation (DBS) is a widely used and effective therapy for several neurologic disorders, such as idiopathic Parkinson's disease, dystonia or tremor. DBS is based on the delivery of electrical stimuli to specific deep anatomic structures of the central nervous system. However, the mechanisms underlying the effect of DBS remain enigmatic. This has led to an interest in investigating the impact of DBS in animal models, especially in rats. As DBS is a long-term therapy, research should be focused on molecular-genetic changes of neural circuits that occur several weeks after DBS. Long-term DBS in rats is challenging because the rats move around in their cage, which causes problems in keeping in place the wire leading from the head of the animal to the stimulator. Furthermore, target structures for stimulation in the rat brain are small and therefore electrodes cannot easily be placed at the required position. Thus, a set-up for long-lasting stimulation of rats using platinum/iridium electrodes with an impedance of about 1 MΩ was developed for this study. An electrode with these specifications allows for not only adequate stimulation but also recording of deep brain structures to identify the target area for DBS. In our set-up, an electrode with a plug for the wire was embedded in dental cement with four anchoring screws secured onto the skull. The wire from the plug to the stimulator was protected by a stainless-steel spring. A swivel was connected to the circuit to prevent the wire from becoming tangled. Overall, this stimulation set-up offers a high degree of free mobility for the rat and enables the head plug, as well as the wire connection between the plug and the stimulator, to retain long-lasting strength.
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Affiliation(s)
- Felix Fluri
- Department of Neurology, University Hospital Wuerzburg
| | | | - Jens Volkmann
- Department of Neurology, University Hospital Wuerzburg
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Scelzo E, Mehrkens JH, Bötzel K, Krack P, Mendes A, Chabardès S, Polosan M, Seigneuret E, Moro E, Fraix V. Deep Brain Stimulation during Pregnancy and Delivery: Experience from a Series of "DBS Babies". Front Neurol 2015; 6:191. [PMID: 26388833 PMCID: PMC4556026 DOI: 10.3389/fneur.2015.00191] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/17/2015] [Indexed: 01/11/2023] Open
Abstract
Introduction Deep brain stimulation (DBS) is widely used to improve quality of life in movement disorders (MD) and psychiatric diseases. Even though the ability to have children has a big impact on patients’ life, only a few studies describe the role of DBS in pregnancy. Objective To describe risks and management of women treated by DBS for disabling MD or psychiatric diseases during pregnancy and delivery. Methods We report a retrospective case series of women, followed in two DBS centers, who became pregnant and went on to give birth to a child while suffering from disabling MD or psychiatric diseases [Parkinson’s disease, dystonia, Tourette’s syndrome (TS), Obsessive Compulsive Disorder (OCD)] treated by DBS. Clinical status, complications and management before, during, and after pregnancy are reported. Two illustrative cases are described in greater detail. Results DBS improved motor and behavioral disorders in all patients and allowed reduction in, or even total interruption of disease-specific medication during pregnancy. With the exception of the spontaneous early abortion of one fetus in a twin pregnancy, all pregnancies were uneventful in terms of obstetric and pediatric management. DBS parameters were adjusted in five patients in order to limit clinical worsening during pregnancy. Implanted material limited breast-feeding in one patient because of local pain at submammal stimulator site and led to local discomfort related to stretching of the cable with increasing belly size in another patient whose stimulator was implanted in the abdominal wall. Conclusion Not only is it safe for young women with MD, TS and OCD who have a DBS-System implanted to become pregnant and give birth to a baby but DBS seems to be the key to becoming pregnant, having children, and thus greatly improves quality of life.
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Affiliation(s)
- Emma Scelzo
- Department of Neurology, Policlinico San Donato, Milan University , Milan , Italy ; Clinical Center for Neurotechnology, Neurostimulation and Movement Disorders, Fondazione IRCCS Ca' Granda - Ospedale Maggiore di Milano , Milan , Italy ; Department of Neurology, Grenoble University Hospital , Grenoble , France
| | - Jan H Mehrkens
- Department of Neurosurgery, Ludwig-Maximilians-University , Munich , Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig-Maximilians-University , Munich , Germany
| | - Paul Krack
- Department of Neurology, Grenoble University Hospital , Grenoble , France ; Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University , Grenoble , France
| | - Alexandre Mendes
- Department of Neurology, Porto University Hospital , Porto , Portugal
| | - Stéphan Chabardès
- Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University , Grenoble , France ; Department of Neurosurgery, Grenoble University Hospital , Grenoble , France
| | - Mircea Polosan
- Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University , Grenoble , France ; Department of Neuropsychiatry, Grenoble University Hospital , Grenoble , France
| | - Eric Seigneuret
- Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University , Grenoble , France ; Department of Neurosurgery, Grenoble University Hospital , Grenoble , France
| | - Elena Moro
- Department of Neurology, Grenoble University Hospital , Grenoble , France ; Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University , Grenoble , France
| | - Valerie Fraix
- Department of Neurology, Grenoble University Hospital , Grenoble , France ; Grenoble Institute of Neurosciences, INSERM U836, Joseph Fourier University , Grenoble , France
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Müller S, Riedmüller R, van Oosterhout A. Rivaling paradigms in psychiatric neurosurgery: adjustability versus quick fix versus minimal-invasiveness. Front Integr Neurosci 2015; 9:27. [PMID: 25883557 PMCID: PMC4383041 DOI: 10.3389/fnint.2015.00027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 03/17/2015] [Indexed: 11/26/2022] Open
Abstract
In the wake of deep brain stimulation (DBS) development, ablative neurosurgical procedures are seeing a comeback, although they had been discredited and nearly completely abandoned in the 1970s because of their unethical practice. Modern stereotactic ablative procedures as thermal or radiofrequency ablation, and particularly radiosurgery (e.g., Gamma Knife) are much safer than the historical procedures, so that a re-evaluation of this technique is required. The different approaches of modern psychiatric neurosurgery refer to different paradigms: microsurgical ablative procedures is based on the paradigm ‘quick fix,’ radiosurgery on the paradigm ‘minimal-invasiveness,’ and DBS on the paradigm ‘adjustability.’ From a mere medical perspective, none of the procedures is absolutely superior; rather, they have different profiles of advantages and disadvantages. Therefore, individual factors are crucial in decision-making, particularly the patients’ social situation, individual preferences, and individual attitudes. The different approaches are not only rivals, but also enriching mutually. DBS is preferable for exploring new targets, which may become candidates for ablative microsurgery or radiosurgery.
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Affiliation(s)
- Sabine Müller
- Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, CCM, Mind and Brain Research Berlin, Germany
| | - Rita Riedmüller
- Charité-Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, CCM, Mind and Brain Research Berlin, Germany
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Anthofer JM, Steib K, Fellner C, Lange M, Brawanski A, Schlaier J. DTI-based deterministic fibre tracking of the medial forebrain bundle. Acta Neurochir (Wien) 2015; 157:469-77. [PMID: 25585836 DOI: 10.1007/s00701-014-2335-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 12/24/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the medial forebrain bundle (MFB) was reported to reduce symptoms in psychiatric disorders. The aim of our study was to find standardised parameters for diffusion tensor imaging (DTI) based fibre tracking to reliably visualise the MFB. METHODS Twenty-two cerebral hemispheres in 11 patients were investigated. Three different regions of interest (ROIs) were defined as seed regions for fibre tracking: the ipsilateral and contralateral superior cerebellar peduncle (SCP) and the nucleus raphe dorsalis (NRD). From each seed region the fibres were followed separately through the ventral tegmental area (VTA = second ROI) and their further courses and volumina were documented and compared. Minimal fibre length was set at 30 mm and the FA threshold at 0.12. RESULTS The fibre tracts starting in seed regions in the ipsilateral SCP and the NRD follow a similar course along the lateral wall of the third ventricle (hypothalamus) and the anterior limb of the internal capsule (ALIC) to inferior fronto-medial brain areas. These fibres are in accordance with the course of the MFB as described in various anatomical atlases. Consistently, a branch leaves the main fibre tract laterally to take a course through the capsula externa to the temporo-parietal cortex. Fibre tracts starting from the contralateral SCP follow a more superior and lateral course, including the dentato-rubro-thalamic and the pyramidal tract. CONCLUSIONS Deterministic fibre tracking with standardised ROIs provides constant and reproducible delineations of the medial forebrain bundle. Its visualisation might help to adjust targeting in DBS for psychiatric disorders.
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Affiliation(s)
- Judith Maria Anthofer
- Department of Neurosurgery, University Hospital of Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany,
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Smith KM, Spindler MA. Uncommon applications of deep brain stimulation in hyperkinetic movement disorders. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5:278. [PMID: 25713746 PMCID: PMC4314611 DOI: 10.7916/d84x56hp] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/20/2014] [Indexed: 12/12/2022]
Abstract
Background In addition to the established indications of tremor and dystonia, deep brain stimulation (DBS) has been utilized less commonly for several hyperkinetic movement disorders, including medication-refractory myoclonus, ballism, chorea, and Gilles de la Tourette (GTS) and tardive syndromes. Given the lack of adequate controlled trials, it is difficult to translate published reports into clinical use. We summarize the literature, draw conclusions regarding efficacy when possible, and highlight concerns and areas for future study. Methods A Pubmed search was performed for English-language articles between January 1980 and June 2014. Studies were selected if they focused primarily on DBS to treat the conditions of focus. Results We identified 49 cases of DBS for myoclonus-dystonia, 21 for Huntington's disease, 15 for choreacanthocytosis, 129 for GTS, and 73 for tardive syndromes. Bilateral globus pallidus interna (GPi) DBS was the most frequently utilized procedure for all conditions except GTS, in which medial thalamic DBS was more common. While the majority of cases demonstrate some improvement, there are also reports of no improvement or even worsening of symptoms in each condition. The few studies including functional or quality of life outcomes suggest benefit. A limited number of studies included blinded on/off testing. There have been two double-blind controlled trials performed in GTS and a single prospective double-blind, uncontrolled trial in tardive syndromes. Patient characteristics, surgical target, stimulation parameters, and duration of follow-up varied among studies. Discussion Despite these extensive limitations, the literature overall supports the efficacy of DBS in these conditions, in particular GTS and tardive syndromes. For other conditions, the preliminary evidence from small studies is promising and encourages further study.
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Affiliation(s)
- Kara M Smith
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Meredith A Spindler
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Ballester González J, Dvorkin-Gheva A, Silva C, Foster JA, Szechtman H. Nucleus accumbens core and pathogenesis of compulsive checking. Behav Pharmacol 2015; 26:200-16. [PMID: 25426580 PMCID: PMC5398318 DOI: 10.1097/fbp.0000000000000112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 10/16/2014] [Indexed: 11/26/2022]
Abstract
To investigate the role of the nucleus accumbens core (NAc) in the development of quinpirole-induced compulsive checking, rats received an excitotoxic lesion of NAc or sham lesion and were injected with quinpirole (0.5 mg/kg) or saline; development of checking behavior was monitored for 10 biweekly tests. The results showed that even after the NAc lesion, quinpirole still induced compulsive checking, suggesting that the pathogenic effects produced by quinpirole lie outside the NAc. Although the NAc lesion did not prevent the induction of compulsive checking, it altered how quickly it develops, suggesting that the NAc normally contributes toward the induction of compulsive checking. Saline-treated rats with an NAc lesion were hyperactive, but did not develop compulsive checking, indicating that hyperactivity by itself is not sufficient for the pathogenesis of compulsive checking. It is proposed that compulsive checking is the exaggerated output of a security motivation system and that the NAc serves as a neural hub for coordinating the orderly activity of neural modules of this motivational system. Evidence is considered suggesting that the neurobiological condition for the pathogenesis of compulsive checking is two-fold: activation of dopamine D2/D3 receptors without concurrent stimulation of D1-like receptors and long-term plastic changes related to quinpirole-induced sensitization.
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Affiliation(s)
| | - Anna Dvorkin-Gheva
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Charmaine Silva
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jane A. Foster
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Henry Szechtman
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
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