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Skandalakis GP, Neudorfer C, Payne CA, Bond E, Tavakkoli AD, Barrios-Martinez J, Trutti AC, Koutsarnakis C, Coenen VA, Komaitis S, Hadjipanayis CG, Stranjalis G, Yeh FC, Banihashemi L, Hong J, Lozano AM, Kogan M, Horn A, Evans LT, Kalyvas A. Establishing connectivity through microdissections of midbrain stimulation-related neural circuits. Brain 2024; 147:3083-3098. [PMID: 38808482 PMCID: PMC11370807 DOI: 10.1093/brain/awae173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/21/2024] [Indexed: 05/30/2024] Open
Abstract
Comprehensive understanding of the neural circuits involving the ventral tegmental area is essential for elucidating the anatomofunctional mechanisms governing human behaviour, in addition to the therapeutic and adverse effects of deep brain stimulation for neuropsychiatric diseases. Although the ventral tegmental area has been targeted successfully with deep brain stimulation for different neuropsychiatric diseases, the axonal connectivity of the region is not fully understood. Here, using fibre microdissections in human cadaveric hemispheres, population-based high-definition fibre tractography and previously reported deep brain stimulation hotspots, we find that the ventral tegmental area participates in an intricate network involving the serotonergic pontine nuclei, basal ganglia, limbic system, basal forebrain and prefrontal cortex, which is implicated in the treatment of obsessive-compulsive disorder, major depressive disorder, Alzheimer's disease, cluster headaches and aggressive behaviours.
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Affiliation(s)
- Georgios P Skandalakis
- Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens 10676, Greece
| | - Clemens Neudorfer
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- MGH Neurosurgery & Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Caitlin A Payne
- Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Evalina Bond
- Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Armin D Tavakkoli
- Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
| | | | - Anne C Trutti
- Integrative Model-Based Cognitive Neuroscience Research Unit, University of Amsterdam, Amsterdam 15926, The Netherlands
| | - Christos Koutsarnakis
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens 10676, Greece
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Freiburg 79106, Germany
- Medical Faculty of the University of Freiburg, Freiburg 79110, Germany
- Center for Deep Brain Stimulation, Medical Center of the University of Freiburg, Freiburg 79106, Germany
| | - Spyridon Komaitis
- Queens Medical Center, Nottingham University Hospitals NHS Foundation Trust, Nottingham NG7 2UH, UK
| | | | - George Stranjalis
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens 10676, Greece
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Layla Banihashemi
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15213, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Jennifer Hong
- Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Andres M Lozano
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, ON M5T 1P5, Canada
| | - Michael Kogan
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM 87106, USA
| | - Andreas Horn
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- MGH Neurosurgery & Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Linton T Evans
- Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA
| | - Aristotelis Kalyvas
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, ON M5T 1P5, Canada
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Fanty L, Yu J, Chen N, Fletcher D, Hey G, Okun M, Wong J. The current state, challenges, and future directions of deep brain stimulation for obsessive compulsive disorder. Expert Rev Med Devices 2023; 20:829-842. [PMID: 37642374 DOI: 10.1080/17434440.2023.2252732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is clinically and pathologically heterogenous, with symptoms often refractory to first-line treatments. Deep brain stimulation (DBS) for the treatment of refractory OCD provides an opportunity to adjust and individualize neuromodulation targeting aberrant circuitry underlying OCD. The tailoring of DBS therapy may allow precision in symptom control based on patient-specific pathology. Progress has been made in understanding the potential targets for DBS intervention; however, a consensus on an optimal target has not been agreed upon. AREAS COVERED A literature review of DBS for OCD was performed by querying the PubMed database. The following topics were covered: the evolution of DBS targeting in OCD, the concept of an underlying unified connectomic network, current DBS targets, challenges facing the field, and future directions which could advance personalized DBS in this challenging population. EXPERT OPINION To continue the increasing efficacy of DBS for OCD, we must further explore the optimal DBS response across clinical profiles and neuropsychiatric domains of OCD as well as how interventions targeting multiple points in an aberrant circuit, multiple aberrant circuits, or a connectivity hub impact clinical response. Additionally, biomarkers would be invaluable in programming adjustments and creating a closed-loop paradigm to address symptom fluctuation in daily life.
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Affiliation(s)
- Lauren Fanty
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Jun Yu
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Nita Chen
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Drew Fletcher
- College of Medicine, University of Florida Health Science Center, Gainesville, FL, USA
| | - Grace Hey
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
- College of Medicine, University of Florida Health Science Center, Gainesville, FL, USA
| | - Michael Okun
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Josh Wong
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
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Yang C, Xiao K, Ao Y, Cui Q, Jing X, Wang Y. The thalamus is the causal hub of intervention in patients with major depressive disorder: Evidence from the Granger causality analysis. Neuroimage Clin 2023; 37:103295. [PMID: 36549233 PMCID: PMC9795532 DOI: 10.1016/j.nicl.2022.103295] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Major depressive disorder (MDD) is the leading mental disorder and afflicts more than 350 million people worldwide. The underlying neural mechanisms of MDD remain unclear, hindering the accurate treatment. Recent brain imaging studies have observed functional abnormalities in multiple brain regions in patients with MDD, identifying core brain regions is the key to locating potential therapeutic targets for MDD. The Granger causality analysis (GCA) measures directional effects between brain regions and, therefore, can track causal hubs as potential intervention targets for MDD. We reviewed literature employing GCA to investigate abnormal brain connections in patients with MDD. The total degree of effective connections in the thalamus (THA) is more than twice that in traditional targets such as the superior frontal gyrus and anterior cingulate cortex. Altered causal connections in patients with MDD mainly included enhanced bottom-up connections from the thalamus to various cortical and subcortical regions and reduced top-down connections from these regions to the THA, indicating excessive uplink sensory information and insufficient downlink suppression information for negative emotions. We suggest that the thalamus is the most crucial causal hub for MDD, which may serve as the downstream target for non-invasive brain stimulation and medication approaches in MDD treatment.
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Affiliation(s)
- Chengxiao Yang
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Kunchen Xiao
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Yujia Ao
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China
| | - Qian Cui
- School of Public Affairs and Administration, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xiujuan Jing
- Tianfu College of Southwestern University of Finance and Economics, Chengdu 610052, China
| | - Yifeng Wang
- Institute of Brain and Psychological Sciences, Sichuan Normal University, Chengdu, China.
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Carrillo-Ruiz JD, Armas-Salazar A, Navarro-Olvera JL, Beltrán JQ, Bowles B, González-Garibay G, Lee Á. Bibliometric Analysis of Mexican Publications on Stereotactic and Functional Neurosurgery From 1949 to 2021. Front Surg 2022; 9:886391. [PMID: 35615655 PMCID: PMC9124808 DOI: 10.3389/fsurg.2022.886391] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
Background Stereotactic and functional neurosurgery (SFN) is a rapidly evolving field and some emerging countries, especially Mexico, have made significant contributions to this discipline. A bibliometric analysis has never been performed in Latin America, and this would be particularly important to show the areas that remain poorly studied, and design research strategies for the future. Methods Scopus was queried using keywords pertaining to functional neurosurgery, restricting the affiliation country to Mexico, and considering documents published after 1949. Added to the initial search, a complementary literature exploration by author, considering the publications of the most productive neurosurgeons, was performed. A descriptive statistical analysis was carried out. Results From 5,109 articles, only 371 were eligible. Scientific production has gradually increased with time. Epilepsy (31%) and movement disorders (27.4%) were the most studied neurological conditions, whereas the other 41.6% corresponded to pain, behavior disorders, spinal cord injuries, neuromodulation, stereotactic biopsies, and SFN history. Level of evidence was predominantly level V (59.1%). Publication output is highly skewed to Mexico City, which represents 78.4% of national production. Relative to factors associated with impact of research, publications in English had more citations (28.5 mean citations per paper), and journals with an impact factor greater than one had more than 10 mean citations per paper. Conclusions Mexico has experienced an increase in the productivity of SFN literature, addressing the most prevalent issues in the country (epilepsy and motor disorders). However, it is necessary to report studies with a higher level of evidence, as well as to decentralize the research collaborating with national institutions outside Mexico City. On the other hand, it is imperative to promote scientific production in English and in high-impact indexed journals to increase the visibility of our production. We would like to call upon our colleagues in other countries to reproduce our methodology, in order to determine the factors associated with the impact and productivity on SFN research.
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Affiliation(s)
- José Damián Carrillo-Ruiz
- Unit for Stereotactic and Functional Neurosurgery, and Research Direction, General Hospital of Mexico, Mexico City, Mexico
- Faculty of Health Sciences Direction of Anahuac University Mexico, Mexico City, Mexico
| | - Armando Armas-Salazar
- Unit for Stereotactic and Functional Neurosurgery, and Research Direction, General Hospital of Mexico, Mexico City, Mexico
- Postgraduate Department, School of Higher Education in Medicine, National Polytechnic Institute, Mexico City, Mexico
| | - José Luis Navarro-Olvera
- Unit for Stereotactic and Functional Neurosurgery, and Research Direction, General Hospital of Mexico, Mexico City, Mexico
| | - Jesús Q. Beltrán
- Unit for Stereotactic and Functional Neurosurgery, and Research Direction, General Hospital of Mexico, Mexico City, Mexico
| | - Brigham Bowles
- Instituto Nacional de Neurología y Neurocirugía, Neuroendovascular Therapy, Mexico City, Mexico
| | | | - Ángel Lee
- Instituto Nacional de Neurología y Neurocirugía, Neuroendovascular Therapy, Mexico City, Mexico
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Mexico City, Mexico
- *Correspondence: Ángel Lee
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Yu Q, Guo X, Zhu Z, Feng C, Jiang H, Zheng Z, Zhang J, Zhu J, Wu H. White Matter Tracts Associated With Deep Brain Stimulation Targets in Major Depressive Disorder: A Systematic Review. Front Psychiatry 2022; 13:806916. [PMID: 35573379 PMCID: PMC9095936 DOI: 10.3389/fpsyt.2022.806916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Deep brain stimulation (DBS) has been proposed as a last-resort treatment for major depressive disorder (MDD) and has shown potential antidepressant effects in multiple clinical trials. However, the clinical effects of DBS for MDD are inconsistent and suboptimal, with 30-70% responder rates. The currently used DBS targets for MDD are not individualized, which may account for suboptimal effect. Objective We aim to review and summarize currently used DBS targets for MDD and relevant diffusion tensor imaging (DTI) studies. Methods A literature search of the currently used DBS targets for MDD, including clinical trials, case reports and anatomy, was performed. We also performed a literature search on DTI studies in MDD. Results A total of 95 studies are eligible for our review, including 51 DBS studies, and 44 DTI studies. There are 7 brain structures targeted for MDD DBS, and 9 white matter tracts with microstructural abnormalities reported in MDD. These DBS targets modulate different brain regions implicated in distinguished dysfunctional brain circuits, consistent with DTI findings in MDD. Conclusions In this review, we propose a taxonomy of DBS targets for MDD. These results imply that clinical characteristics and white matter tracts abnormalities may serve as valuable supplements in future personalized DBS for MDD.
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Affiliation(s)
| | | | | | | | | | | | | | - Junming Zhu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hemmings Wu
- Department of Neurosurgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Messina G, Vetrano IG, Bonomo G, Broggi G. Role of deep brain stimulation in management of psychiatric disorders. PROGRESS IN BRAIN RESEARCH 2022; 270:61-96. [PMID: 35396031 DOI: 10.1016/bs.pbr.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Nowadays, most of patients affected by psychiatric disorders are successfully treated with conservative therapies. Still, a variable percentage of them demonstrate resistance to conventional treatments, and alternative methods can then be considered. During the last 20 years, there is a progressive interest in use of deep brain stimulation (DBS) in mental illnesses. It has become clear nowadays, that this modality may be effectively applied under specific indications in some patients with major depressive disorder, obsessive-compulsive disorder, anorexia nervosa and other eating disorders, Tourette syndrome, schizophrenia, substance use disorder, and even pathologically aggressive behavior. Despite the fact that the efficacy of neuromodulation with DBS, as well as of various lesional interventions, in cases of mental illnesses is still not fully established, there are several premises for wider applications of such "unclassical" psychiatric treatments in the future. Novel technologies of DBS, developments in non-invasive lesioning using stereotactic radiosurgery and transcranial magnetic resonance-guided focused ultrasound, and advances of neurophysiological and neuroimaging modalities may bolster further clinical applications of psychiatric neurosurgery, improve its results, and allow for individually selected treatment strategies tailored to specific needs of the patient.
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Affiliation(s)
- Giuseppe Messina
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giulio Bonomo
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Broggi
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Neurosurgery, M Cecilia Hospital-GVM, Ravenna, Italy
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Four Deep Brain Stimulation Targets for Obsessive-Compulsive Disorder: Are They Different? Biol Psychiatry 2021; 90:667-677. [PMID: 32951818 PMCID: PMC9569132 DOI: 10.1016/j.biopsych.2020.06.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
Deep brain stimulation is a promising therapeutic approach for patients with treatment-resistant obsessive-compulsive disorder, a condition linked to abnormalities in corticobasal ganglia networks. Effective targets are placed in one of four subcortical areas with the goal of capturing prefrontal, anterior cingulate, and basal ganglia connections linked to the limbic system. These include the anterior limb of the internal capsule, the ventral striatum, the subthalamic nucleus, and a midbrain target. The goal of this review is to examine these 4 targets with respect to the similarities and differences of their connections. Following a review of the connections for each target based on anatomic studies in nonhuman primates, we examine the accuracy of diffusion magnetic resonance imaging tractography to replicate those connections in nonhuman primates, before evaluating the connections in the human brain based on diffusion magnetic resonance imaging tractography. Results demonstrate that the four targets generally involve similar connections, all of which are part of the internal capsule. Nonetheless, some connections are unique to each site. Delineating the similarities and differences across targets is a critical step for evaluating and comparing the effectiveness of each and how circuits contribute to the therapeutic outcome. It also underscores the importance that the terminology used for each target accurately reflects its position and its anatomic connections, so as to enable comparisons across clinical studies and for basic scientists to probe mechanisms underlying deep brain stimulation.
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Tumova MA, Muslimova LM, Stanovaya VV, Abdyrakhmanova AK, Ivanov MV. [Contemporary methods of non-drug therapy for depression]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:91-98. [PMID: 34405663 DOI: 10.17116/jnevro202112105291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review presents information on the most effective current non-drug methods of treatment of depression used in practice. A review of publications in PubMed and PsycINFO and Cochrane Library over the past 10 years was conducted. Non-drug biological therapies demonstrate high efficacy in the reduction of depressive symptoms in patients with recurrent depressive disorder. The use of non-drug therapy does not preclude the continuation of pharmacological therapy. In order to choose an optimal method of treatment, the psychophysical state of a patient, severity of depressive symptoms, response to drug therapy, and possibility of prescribing pharmacological therapy should be taken into account, and the principles of evidence-based medicine should be taken into consideration when making a decision.
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Affiliation(s)
- M A Tumova
- Bekhterev National Research Medical Centre for Psychiatry and Neurology, St. Petersburg, Russia
| | - L M Muslimova
- Bekhterev National Research Medical Centre for Psychiatry and Neurology, St. Petersburg, Russia
| | - V V Stanovaya
- Bekhterev National Research Medical Centre for Psychiatry and Neurology, St. Petersburg, Russia
| | - A K Abdyrakhmanova
- Bekhterev National Research Medical Centre for Psychiatry and Neurology, St. Petersburg, Russia
| | - M V Ivanov
- Bekhterev National Research Medical Centre for Psychiatry and Neurology, St. Petersburg, Russia
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Hageman SB, van Rooijen G, Bergfeld IO, Schirmbeck F, de Koning P, Schuurman PR, Denys D. Deep brain stimulation versus ablative surgery for treatment-refractory obsessive-compulsive disorder: A meta-analysis. Acta Psychiatr Scand 2021; 143:307-318. [PMID: 33492682 DOI: 10.1111/acps.13276] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/05/2020] [Accepted: 01/10/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Ablative surgery (ABL) and deep brain stimulation (DBS) are last-resort treatment options for patients suffering from treatment-refractory obsessive-compulsive disorder (OCD). The aim of this study was to conduct an updated meta-analysis comparing the clinical outcomes of the ablative procedures capsulotomy and cingulotomy and deep brain stimulation. METHODS We conducted a PubMed search to identify all clinical trials on capsulotomy, cingulotomy, and DBS. Random effects meta-analyses were performed on 38 articles with a primary focus on efficacy in reducing OCD symptoms as measured by a reduction in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score and the responder rate (≥35% reduction in Y-BOCS score). RESULTS With responder rates of 48% and 53% after 12-16 months and 56% and 57% at last follow-up for ABL and DBS, respectively, and large effect sizes in the reduction in Y-BOCS scores, both surgical modalities show effectiveness in treating refractory OCD. Meta-regression did not show a statistically significant difference between ABL and DBS regarding these outcomes. Regarding adverse events, a statistically significant higher rate of impulsivity is reported in studies on DBS. CONCLUSION This meta-analysis shows equal efficacy of ABL and DBS in the treatment of refractory OCD. For now, the choice of intervention should, therefore, rely on factors such as risk of developing impulsivity, patient preferences, and experiences of psychiatrist and neurosurgeon. Future research should provide more insight regarding differences between ABL and DBS and response prediction following direct comparisons between the surgical modalities, to enable personalized and legitimate choices between ABL and DBS.
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Affiliation(s)
- Sarah Babette Hageman
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Geeske van Rooijen
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Isidoor O Bergfeld
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederike Schirmbeck
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Arkin Institute for Mental Health, Amsterdam, the Netherlands
| | - Pelle de Koning
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - P Rick Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.,The Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
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10
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Alternatives to Pharmacological and Psychotherapeutic Treatments in Psychiatric Disorders. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Nowadays, most of the patients affected by psychiatric disorders are successfully treated with psychotherapy and pharmacotherapy. Nevertheless, according to the disease, a variable percentage of patients results resistant to such modalities, and alternative methods can then be considered. The purpose of this review is to summarize the techniques and results of invasive modalities for several treatment-resistant psychiatric diseases. A literature search was performed to provide an up-to-date review of advantages, disadvantages, efficacy, and complications of Deep-Brain Stimulation, Magnetic Resonance-guided Focused-Ultrasound, radiofrequency, and radiotherapy lesioning for depression, obsessive-compulsive disorder, schizophrenia, addiction, anorexia nervosa, and Tourette’s syndrome. The literature search did not strictly follow the criteria for a systematic review: due to the large differences in methodologies and patients’ cohort, we tried to identify the highest quality of available evidence for each technique. We present the data as a comprehensive, narrative review about the role, indication, safety, and results of the contemporary instrumental techniques that opened new therapeutic fields for selected patients unresponsive to psychotherapy and pharmacotherapy.
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Beltrán JQ, Carrillo-Ruiz JD. Neurological Functional Surgery in Mexico: From Pre-Columbian Cranial Surgery to Functional Neurosurgery in the 21st Century. World Neurosurg 2019; 122:549-558. [DOI: 10.1016/j.wneu.2018.11.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 01/28/2023]
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12
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Drobisz D, Damborská A. Deep brain stimulation targets for treating depression. Behav Brain Res 2018; 359:266-273. [PMID: 30414974 DOI: 10.1016/j.bbr.2018.11.004] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/10/2018] [Accepted: 11/05/2018] [Indexed: 12/18/2022]
Abstract
Deep brain stimulation (DBS) is a new therapeutic approach for treatment-resistant depression (TRD). There is a preliminary evidence of the efficacy and safety of DBS for TRD in the subgenual anterior cingulate cortex, the ventral capsule/ventral striatum, the nucleus accumbens, the lateral habenula, the inferior thalamic peduncle, the medial forebrain bundle, and the bed nucleus of the stria terminalis. Optimal stimulation targets, however, have not yet been determined. Here we provide updated knowledge substantiating the suitability of each of the current and potential future DBS targets for treating depression. In this review, we discuss the future outlook for DBS treatment of depression in light of the fact that antidepressant effects of DBS can be achieved using different targets.
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Affiliation(s)
- Dominik Drobisz
- Department of Psychiatry, University Hospital and Masaryk University, Brno, Czech Republic
| | - Alena Damborská
- Department of Psychiatry, University Hospital and Masaryk University, Brno, Czech Republic; Department of Basic Neurosciences, University of Geneva, Campus Biotech, Geneva, Switzerland; CEITEC - Central European Institute of Technology, Brain and Mind Research Program, Masaryk University, Brno, Czech Republic.
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Dandekar MP, Fenoy AJ, Carvalho AF, Soares JC, Quevedo J. Deep brain stimulation for treatment-resistant depression: an integrative review of preclinical and clinical findings and translational implications. Mol Psychiatry 2018; 23:1094-1112. [PMID: 29483673 DOI: 10.1038/mp.2018.2] [Citation(s) in RCA: 177] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/05/2017] [Accepted: 12/15/2017] [Indexed: 02/07/2023]
Abstract
Although deep brain stimulation (DBS) is an established treatment choice for Parkinson's disease (PD), essential tremor and movement disorders, its effectiveness for the management of treatment-resistant depression (TRD) remains unclear. Herein, we conducted an integrative review on major neuroanatomical targets of DBS pursued for the treatment of intractable TRD. The aim of this review article is to provide a critical discussion of possible underlying mechanisms for DBS-generated antidepressant effects identified in preclinical studies and clinical trials, and to determine which brain target(s) elicited the most promising outcomes considering acute and maintenance treatment of TRD. Major electronic databases were searched to identify preclinical and clinical studies that have investigated the effects of DBS on depression-related outcomes. Overall, 92 references met inclusion criteria, and have evaluated six unique DBS targets namely the subcallosal cingulate gyrus (SCG), nucleus accumbens (NAc), ventral capsule/ventral striatum or anterior limb of internal capsule (ALIC), medial forebrain bundle (MFB), lateral habenula (LHb) and inferior thalamic peduncle for the treatment of unrelenting TRD. Electrical stimulation of these pertinent brain regions displayed differential effects on mood transition in patients with TRD. In addition, 47 unique references provided preclinical evidence for putative neurobiological mechanisms underlying antidepressant effects of DBS applied to the ventromedial prefrontal cortex, NAc, MFB, LHb and subthalamic nucleus. Preclinical studies suggest that stimulation parameters and neuroanatomical locations could influence DBS-related antidepressant effects, and also pointed that modulatory effects on monoamine neurotransmitters in target regions or interconnected brain networks following DBS could have a role in the antidepressant effects of DBS. Among several neuromodulatory targets that have been investigated, DBS in the neuroanatomical framework of the SCG, ALIC and MFB yielded more consistent antidepressant response rates in samples with TRD. Nevertheless, more well-designed randomized double-blind, controlled trials are warranted to further assess the efficacy, safety and tolerability of these more promising DBS targets for the management of TRD as therapeutic effects have been inconsistent across some controlled studies.
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Affiliation(s)
- M P Dandekar
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - A J Fenoy
- Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - A F Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - J C Soares
- Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J Quevedo
- Translational Psychiatry Program, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Center of Excellence on Mood Disorders, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.,Neuroscience Graduate Program, The University of Texas Graduate School of Biomedical Sciences at Houston, Houston, TX, USA.,Laboratory of Neurosciences, Graduate Program in Health Sciences, Health Sciences Unit, University of Southern Santa Catarina, Criciúma, Brazil
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Sun C, Wang Y, Cui R, Wu C, Li X, Bao Y, Wang Y. Human Thalamic-Prefrontal Peduncle Connectivity Revealed by Diffusion Spectrum Imaging Fiber Tracking. Front Neuroanat 2018; 12:24. [PMID: 29719502 PMCID: PMC5913328 DOI: 10.3389/fnana.2018.00024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/15/2018] [Indexed: 12/16/2022] Open
Abstract
The thalamic-prefrontal peduncle (TPP) is a large bundle connecting the thalamus and prefrontal cortex. The definitive structure and function of the TPP are still controversial. To investigate the connectivity and segmentation patterns of the TPP, we employed diffusion spectrum imaging with generalized q-sampling reconstruction to perform both subject-specific and template-based analyses. Our results confirmed the trajectory and spatial relationship of the TPP in the human brain and identified the connection areas in the prefrontal cortex. The TPP-connecting areas identified based on Brodmann areas (BAs) were BAs 8–11 and 45–47. Based on the automated anatomical atlas, these areas were the medial superior frontal gyrus, superior frontal gyrus, middle frontal gyrus, pars triangularis, pars orbitalis, anterior orbital gyrus, and lateral orbital gyrus. In addition, we identified the TPP connection areas in the thalamus, including the anterior and medial nuclei, and the lateral dorsal/lateral posterior nuclei. TPP fibers connected the thalamus with the ipsilateral prefrontal BAs 11, 47, 10, 46, 45, 9, and 8 seriatim from medial to lateral, layer by layer. Our results provide further details of the thalamic-prefrontal peduncle structure, and may aid future studies and a better understanding of the functional roles of the TPP in the human brain.
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Affiliation(s)
- Chuanqi Sun
- Department of Innovative Medical Photonics, Preeminent Medical Photonics Education & Research Center, Institute for Photonics Research, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yibao Wang
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Run Cui
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chong Wu
- Department of Neurosurgery, Anshan Central Hospital, Anshan, China
| | - Xinguo Li
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yue Bao
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yong Wang
- Department of Neurosurgery, First Affiliated Hospital of China Medical University, Shenyang, China
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Ramasubbu R, Lang S, Kiss ZHT. Dosing of Electrical Parameters in Deep Brain Stimulation (DBS) for Intractable Depression: A Review of Clinical Studies. Front Psychiatry 2018; 9:302. [PMID: 30050474 PMCID: PMC6050377 DOI: 10.3389/fpsyt.2018.00302] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/18/2018] [Indexed: 01/16/2023] Open
Abstract
Background: The electrical parameters used for deep brain stimulation (DBS) in movement disorders have been relatively well studied, however for the newer indications of DBS for psychiatric indications these are less clear. Based on the movement disorder literature, use of the correct stimulation parameters should be crucial for clinical outcomes. This review examines the stimulation parameters used in DBS studies for treatment resistant depression (TRD) and their relevance to clinical outcome and brain targets. Methods: We examined the published studies on DBS for TRD archived in major databases. Data on stimulus parameters (frequency, pulse width, amplitude), stimulation mode, brain target, efficacy, safety, and duration of follow up were extracted from 29 observational studies including case reports of patients with treatment resistant unipolar, bipolar, and co-morbid depression. Results: The algorithms commonly used to optimize efficacy were increasing amplitude followed by changing the electric contacts or increasing pulse width. High frequency stimulation (>100 Hz) was applied in most cases across brain targets. Keeping the high frequency stimulation constant, three different combinations of parameters were mainly used: (i) short pulse width (60-90 us) and low amplitude (0-4 V), (ii) short pulse width and high amplitude (5-10 V), (iii) long pulse width (120-450 us) and low amplitude. There were individual variations in clinical response to electrical dosing and also in the time of clinical recovery. There was no significant difference in mean stimulation parameters between responders and non-responders suggesting a role for stimulation unrelated factors in response. Conclusions: Although limited by open trials and small sample size, three optimal stimulation parameter combinations emerged from this review. Studies are needed to assess the comparative efficacy and safety of these combinations, such as a registry of data from patients undergoing DBS for TRD with individual data on stimulation parameters.
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Affiliation(s)
- Rajamannar Ramasubbu
- Department of Psychiatry and Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Stefan Lang
- Department of Psychiatry and Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Zelma H T Kiss
- Department of Psychiatry and Clinical Neurosciences, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Neudorfer C, El Majdoub F, Hunsche S, Richter K, Sturm V, Maarouf M. Deep Brain Stimulation of the H Fields of Forel Alleviates Tics in Tourette Syndrome. Front Hum Neurosci 2017; 11:308. [PMID: 28659777 PMCID: PMC5468420 DOI: 10.3389/fnhum.2017.00308] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/29/2017] [Indexed: 12/29/2022] Open
Abstract
The current rationale for target selection in Tourette syndrome revolves around the notion of cortico-basal ganglia circuit involvement in the pathophysiology of the disease. However, despite extensive research, the ideal target for deep brain stimulation (DBS) is still under debate, with many structures being neglected and underexplored. Based on clinical observations and taking into account the prevailing hypotheses of network processing in Tourette syndrome, we chose the fields of Forel, namely field H1, as a target for DBS. The fields of Forel constitute the main link between the striatopallidal system and the thalamocortical network, relaying pallidothalamic projections from core anatomical structures to the thalamic ventral nuclear group. In a retrospective study we investigated two patients suffering from chronic, medically intractable Tourette syndrome who underwent bilateral lead implantation in field H1 of Forel. Clinical scales revealed significant alleviation of tics and comorbid symptoms, namely depression and anxiety, in the postoperative course in both patients.
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Affiliation(s)
- Clemens Neudorfer
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
| | - Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
| | - Stefan Hunsche
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
| | - Klaus Richter
- Department of Psychiatry and Psychotherapy, LVR Clinics CologneCologne, Germany
| | - Volker Sturm
- Department of Neurosurgery, University Hospital of WürzburgWürzburg, Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center, Witten/Herdecke UniversityCologne, Germany
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Naesström M, Blomstedt P, Bodlund O. A systematic review of psychiatric indications for deep brain stimulation, with focus on major depressive and obsessive-compulsive disorder. Nord J Psychiatry 2016; 70:483-91. [PMID: 27103550 DOI: 10.3109/08039488.2016.1162846] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Deep brain stimulation is a treatment under investigation for a range of psychiatric disorders. It has shown promising results for therapy-refractory obsessive-compulsive disorder (OCD) and major depressive disorder (MDD). Other indications under investigation include Tourette's syndrome, anorexia nervosa and substance use disorders. AIMS To review current studies on psychiatric indications for deep brain stimulation (DBS), with focus on OCD and MDD. METHOD A systematic search was carried out in MEDLINE, and the literature was searched to identify studies with DBS for psychiatric disorders. The identified studies were analysed based on patient characteristics, treatment results and adverse effects of DBS. RESULTS A total of 52 papers met the inclusion criteria and described a total of 286 unique patients treated with DBS for psychiatric indications; 18 studies described 112 patients treated with DBS for OCD in six different anatomical targets, while nine studies presented 100 patients with DBS for MDD in five different targets. CONCLUSION DBS may show promise for treatment-resistant OCD and MDD but the results are limited by small sample size and insufficient randomized controlled data. Deep brain stimulation for OCD has received United States Food and Drug Administration approval. Other psychiatric indications are currently of a purely experimental nature.
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Affiliation(s)
- Matilda Naesström
- a Department of Clinical Sciences/Psychiatry , Umeå University , Umeå , Sweden
| | - Patric Blomstedt
- b Department of Pharmacology and Clinical Neuroscience , Umeå University , Umeå , Sweden
| | - Owe Bodlund
- a Department of Clinical Sciences/Psychiatry , Umeå University , Umeå , Sweden
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18
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Maarouf M, Neudorfer C, El Majdoub F, Lenartz D, Kuhn J, Sturm V. Deep Brain Stimulation of Medial Dorsal and Ventral Anterior Nucleus of the Thalamus in OCD: A Retrospective Case Series. PLoS One 2016; 11:e0160750. [PMID: 27504631 PMCID: PMC4978440 DOI: 10.1371/journal.pone.0160750] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/25/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The current notion that cortico-striato-thalamo-cortical circuits are involved in the pathophysiology of obsessive-compulsive disorder (OCD) has instigated the search for the most suitable target for deep brain stimulation (DBS). However, despite extensive research, uncertainty about the ideal target remains with many structures being underexplored. The aim of this report is to address a new target for DBS, the medial dorsal (MD) and the ventral anterior (VA) nucleus of the thalamus, which has thus far received little attention in the treatment of OCD. METHODS In this retrospective trial, four patients (three female, one male) aged 31-48 years, suffering from therapy-refractory OCD underwent high-frequency DBS of the MD and VA. In two patients (de novo group) the thalamus was chosen as a primary target for DBS, whereas in two patients (rescue DBS group) lead implantation was performed in a rescue DBS attempt following unsuccessful primary stimulation. RESULTS Continuous thalamic stimulation yielded no significant improvement in OCD symptom severity. Over the course of thalamic DBS symptoms improved in only one patient who showed "partial response" on the Yale-Brown Obsessive Compulsive (Y-BOCS) Scale. Beck Depression Inventory scores dropped by around 46% in the de novo group; anxiety symptoms improved by up to 34%. In the de novo DBS group no effect of DBS on anxiety and mood was observable. CONCLUSION MD/VA-DBS yielded no adequate alleviation of therapy-refractory OCD, the overall strategy in targeting MD/VA as described in this paper can thus not be recommended in DBS for OCD. The magnocellular portion of MD (MDMC), however, might prove a promising target in the treatment of mood related and anxiety disorders.
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Affiliation(s)
- Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
- * E-mail:
| | - Clemens Neudorfer
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Doris Lenartz
- Department of Stereotaxy and Functional Neurosurgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Jens Kuhn
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | - Volker Sturm
- Department of Neurosurgery, University Hospital of Würzburg, Würzburg, Germany
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Bari AA, King NKK, Lipsman N, Lozano AM. Deep Brain Stimulation for Neuropsychiatric Disorders. Transl Neurosci 2016. [DOI: 10.1007/978-1-4899-7654-3_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Yagmurlu K, Vlasak AL, Rhoton AL. Three-dimensional topographic fiber tract anatomy of the cerebrum. Neurosurgery 2015; 11 Suppl 2:274-305; discussion 305. [PMID: 25950888 DOI: 10.1227/neu.0000000000000704] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The fiber tracts of the cerebrum may be a more important determinant of resection limits than the cortex. Better knowledge of the 3-dimensional (3-D) anatomic organization of the fiber pathways is important in planning safe and accurate surgery for lesions within the cerebrum. OBJECTIVE To examine the topographic anatomy of fiber tracts and subcortical gray matter of the human cerebrum and their relationships with consistent cortical, ventricular, and nuclear landmarks. METHODS Twenty-five formalin-fixed human brains and 4 whole cadaveric heads were examined by fiber dissection technique and ×6 to ×40 magnification. The fiber tracts and central core structures, including the insula and basal ganglia, were examined and their relationships captured in 3-D photography. The depth between the surface of the cortical gyri and selected fiber tracts was measured. RESULTS The topographic relationships of the important association, projection, and commissural fasciculi within the cerebrum and superficial cortical landmarks were identified. Important landmarks with consistent relationships to the fiber tracts were the cortical gyri and sulci, limiting sulci of the insula, nuclear masses in the central core, and lateral ventricles. The fiber tracts were also organized in a consistent pattern in relation to each other. The anatomic findings are briefly compared with functional data from clinicoradiological analysis and intraoperative stimulation of fiber tracts. CONCLUSION An understanding of the 3-D anatomic organization of the fiber tracts of the brain is essential in planning safe and accurate cerebral surgery.
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Affiliation(s)
- Kaan Yagmurlu
- Department of Neurosurgery, University of Florida, College of Medicine, Gainesville, Florida
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Alonso P, Cuadras D, Gabriëls L, Denys D, Goodman W, Greenberg BD, Jimenez-Ponce F, Kuhn J, Lenartz D, Mallet L, Nuttin B, Real E, Segalas C, Schuurman R, Tezenas du Montcel S, Menchon JM. Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response. PLoS One 2015. [PMID: 26208305 PMCID: PMC4514753 DOI: 10.1371/journal.pone.0133591] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Deep brain stimulation (DBS) has been proposed as an alternative to ablative neurosurgery for severe treatment-resistant Obsessive-Compulsive Disorder (OCD), although with partially discrepant results probably related to differences in anatomical targetting and stimulation conditions. We sought to determine the efficacy and tolerability of DBS in OCD and the existence of clinical predictors of response using meta-analysis. Methods We searched the literature on DBS for OCD from 1999 through January 2014 using PubMed/MEDLINE and PsycINFO. We performed fixed and random-effect meta-analysis with score changes (pre-post DBS) on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) as the primary-outcome measure, and the number of responders to treatment, quality of life and acceptability as secondary measures. Findings Thirty-one studies involving 116 subjects were identified. Eighty-three subjects were implanted in striatal areas—anterior limb of the internal capsule, ventral capsule and ventral striatum, nucleus accumbens and ventral caudate—27 in the subthalamic nucleus and six in the inferior thalamic peduncle. Global percentage of Y-BOCS reduction was estimated at 45.1% and global percentage of responders at 60.0%. Better response was associated with older age at OCD onset and presence of sexual/religious obsessions and compulsions. No significant differences were detected in efficacy between targets. Five patients dropped out, but adverse effects were generally reported as mild, transient and reversible. Conclusions Our analysis confirms that DBS constitutes a valid alternative to lesional surgery for severe, therapy-refractory OCD patients. Well-controlled, randomized studies with larger samples are needed to establish the optimal targeting and stimulation conditions and to extend the analysis of clinical predictors of outcome.
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Affiliation(s)
- Pino Alonso
- OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain
- CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain
- Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain
- * E-mail:
| | - Daniel Cuadras
- Methodological and Statistical Assessment Unit, Parc Sanitari Sant Joan de Déu—Fundació Sant Joan de Déu, Barcelona, Spain
| | - Loes Gabriëls
- University Centre for OCD, Department of Psychiatry, UPC-KULeuven, Leuven, Belgium
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Brain Imaging Center, Academic Medical Center, University of Amsterdam, and the Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Wayne Goodman
- Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Ben D. Greenberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Butler Hospital, Providence, Rhode Island, United States of America
| | - Fiacro Jimenez-Ponce
- Unit of Stereotactic, Functional Neurosurgery and Radiosurgery, General Hospital of Mexico, Mexico City, Mexico
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Doris Lenartz
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Luc Mallet
- UPMC-Inserm U1127-CNRS UMR7225, ICM–Brain & Spine Institute, Paris, France
| | - Bart Nuttin
- Department of Neurosurgery, UZ Leuven, KU Leuven, Belgium
| | - Eva Real
- OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain
- CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain
| | - Cinto Segalas
- OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain
- CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain
| | - Rick Schuurman
- Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophie Tezenas du Montcel
- UPMC Univ Paris 06, ER4, Modelling in Clinical Research, Paris, France
- AP-HP, Hopitaux Universitaires Pitié-Salpétrière Charles-Foix, Department of Biostatistics and Medical Informatics, Paris, France
| | - Jose M. Menchon
- OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain
- CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain
- Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain
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Abstract
Major depressive disorder is a worldwide disease with debilitating effects on a patient's life. Common treatments include pharmacotherapy, psychotherapy, and electroconvulsive therapy. Many patients do not respond to these treatments; this has led to the investigation of alternative therapeutic modalities. Deep brain stimulation (DBS) is one of these modalities. It was first used with success for treating movement disorders and has since been extended to the treatment of psychiatric disorders. Although DBS is still an emerging treatment, promising efficacy and safety have been demonstrated in preliminary trials in patients with treatment-resistant depression (TRD). Further, neuroimaging has played a pivotal role in identifying some DBS targets and remains an important tool for evaluating the mechanism of action of this novel intervention. Preclinical animal studies have broadened knowledge about the possible mechanisms of action of DBS for TRD, Given that DBS involves neurosurgery in patients with severe psychiatric impairment, ethical questions concerning capacity to consent arise; these issues must continue to be carefully considered.
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Affiliation(s)
- Sibylle Delaloye
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Paul E Holtzheimer
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Sedrak M, Wong W, Wilson P, Bruce D, Bernstein I, Khandhar S, Pappas C, Heit G, Sabelman E. Deep brain stimulation for the treatment of severe, medically refractory obsessive-compulsive disorder. Perm J 2014; 17:47-51. [PMID: 24361021 DOI: 10.7812/tpp/13-005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Deep brain stimulation is a rapidly expanding therapy initially designed for the treatment of movement disorders and pain syndromes. The therapy includes implantation of electrodes in specific targets of the brain, delivering programmable small and safe electric impulses, like a pacemaker, that modulates both local and broad neurologic networks. The effects are thought to primarily involve a focus in the brain, probably inhibitory, which then restores a network of neural circuitry. Psychiatric diseases can be refractory and severe, leading to high medical costs, significant morbidity, and even death. Whereas surgery for psychiatric disease used to include destructive procedures, deep brain stimulation allows safe, reversible, and adjustable treatment that can be tailored for each patient. Deep brain stimulation offers new hope for these unfortunate patients, and the preliminary results are promising.
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Affiliation(s)
- Mark Sedrak
- Director of Stereotactic and Functional Neurosurgery for The Permanente Medical Group and a Neurosurgeon at the Redwood City Medical Center in CA.
| | - William Wong
- Psychiatrist at the Redwood City Medical Center in CA.
| | - Paul Wilson
- Chief of Psychiatry and a Psychiatrist at the Redwood City Medical Center in CA.
| | - Diana Bruce
- Physician Assistant in Functional Neurosurgery at Redwood City Medical Center in CA.
| | - Ivan Bernstein
- Physician Assistant in Functional Neurosurgery at the Redwood City Medical Center in CA.
| | - Suketu Khandhar
- Director of Movement Disorders for The Permanente Medical Group and a Neurologist at the Sacramento Medical Center in CA.
| | - Conrad Pappas
- Neurosurgeon at the Sacramento Medical Center in CA.
| | - Gary Heit
- Former Director of Stereotactic and Functional Neurosurgery for The Permanente Medical Group in Redwood City, CA.
| | - Eric Sabelman
- Bioengineer in Functional Neurosurgery at Redwood City Medical Center in CA.
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Yampolsky C, Bendersky D. [Surgery for behavioral disorders: the state of the art]. Surg Neurol Int 2014; 5:S211-31. [PMID: 25165612 PMCID: PMC4138826 DOI: 10.4103/2152-7806.137936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Accepted: 08/15/2013] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Surgery for behavioral disorders (SBD) is becoming a more common treatment since the development of neuromodulation techniques. METHODS This article is a non-systematic review of the history, current indications, techniques and surgical targets of SBD. We divide its history into 3 eras: the first era starts in the beginning of psychosurgery and finishes with the development of stereotactic techniques, when the second one starts. It is characterized by the realization of stereotactic lesions. We are traveling through the third era, which begins when deep brain stimulation (DBS) starts to be used for SBD. RESULTS In spite of the serious mistakes committed in the past, nowadays, SBD is reawakening. The psychiatric disorders which are most frequently treated by surgery are: treatment-resistant depression, obsessive-compulsive disorder and Tourette syndrome. Furthermore, some patients with abnormal aggression were surgically treated. There are several stereotactic targets described for these disorders. Vagus nerve stimulation may be also used for depression. CONCLUSION The results of DBS in these disorders seem to be encouraging. However, more randomized trials are needed in order to establish the effectiveness of SBD. It must be taken in mind that a proper patient selection will help us to perform a safer procedure as well as to achieve better surgical results, leading SBD to be more accepted by psychiatrists, patients and their families. Further research is needed in several topics such as: physiopathology of behavioral disorders, indications of SBD and new surgical targets.
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Affiliation(s)
- Claudio Yampolsky
- Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Damián Bendersky
- Servicio de Neurocirugía, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Neuromodulation for depression: invasive and noninvasive (deep brain stimulation, transcranial magnetic stimulation, trigeminal nerve stimulation). Neurosurg Clin N Am 2014; 25:103-16. [PMID: 24262903 DOI: 10.1016/j.nec.2013.10.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Major depressive disorder is among the most disabling illnesses and, despite best practices with medication and psychotherapy, many patients remain ill even after several treatment trials. For many of these patients with treatment-resistant or pharmacoresistant depression, treatment with neuromodulation offers an alternative. Options range from systems that are implanted to others that are entirely noninvasive. This review surveys recent literature to update readers on 3 particular interventions: deep brain stimulation, transcranial magnetic stimulation, and trigeminal nerve stimulation. Additional comparative research is needed to delineate the relative advantages of these treatments, and how best to match individual patients to neuromodulation intervention.
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Morishita T, Fayad SM, Higuchi MA, Nestor KA, Foote KD. Deep brain stimulation for treatment-resistant depression: systematic review of clinical outcomes. Neurotherapeutics 2014; 11:475-84. [PMID: 24867326 PMCID: PMC4121451 DOI: 10.1007/s13311-014-0282-1] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Major depressive disorder (MDD) is a widespread, severe, debilitating disorder that markedly diminishes quality of life. Medication is commonly effective, but 20-30 % of patients are refractory to medical therapy. The surgical treatment of psychiatric disorders has a negative stigma associated with it owing to historical abuses. Various ablative surgeries for MDD have been attempted with marginal success, but these studies lacked standardized outcome measures. The recent development of neuromodulation therapy, especially deep brain stimulation (DBS), has enabled controlled studies with sham stimulation and presents a potential therapeutic option that is both reversible and adjustable. We performed a systematic review of the literature pertaining to DBS for treatment-resistant depression to evaluate the safety and efficacy of this procedure. We included only studies using validated outcome measures. Our review identified 22 clinical research papers with 5 unique DBS approaches using different targets, including nucleus accumbens, ventral striatum/ventral capsule, subgenual cingulate cortex, lateral habenula, inferior thalamic nucleus, and medial forebrain bundle. Among the 22 published studies, only 3 were controlled trials, and 2, as yet unpublished, multicenter, randomized, controlled trials evaluating the efficacy of subgenual cingulate cortex and ventral striatum/ventral capsule DBS were recently discontinued owing to inefficacy based on futility analyses. Overall, the published response rate to DBS therapy, defined as the percentage of patients with > 50 % improvement on the Hamilton Depression Rating Scale, is reported to be 40-70 %, and outcomes were comparable across studies. We conclude that DBS for MDD shows promise, but remains experimental and further accumulation of data is warranted.
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Affiliation(s)
- Takashi Morishita
- />Department of Neurosurgery, McKnight Brain Institute, University of Florida College of Medicine/Shands Hospital, Center for Movement Disorders and Neurorestoration, 1149 South Newell Drive, Gainesville, FL 32611 USA
| | - Sarah M. Fayad
- />Department of Psychiatry, McKnight Brain Institute, University of Florida College of Medicine/Shands Hospital, Center for Movement Disorders and Neurorestoration, Gainesville, FL USA
| | - Masa-aki Higuchi
- />Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine/Shands Hospital, Center for Movement Disorders and Neurorestoration, Gainesville, FL USA
| | - Kelsey A. Nestor
- />Department of Neurosurgery, McKnight Brain Institute, University of Florida College of Medicine/Shands Hospital, Center for Movement Disorders and Neurorestoration, 1149 South Newell Drive, Gainesville, FL 32611 USA
| | - Kelly D. Foote
- />Department of Neurosurgery, McKnight Brain Institute, University of Florida College of Medicine/Shands Hospital, Center for Movement Disorders and Neurorestoration, 1149 South Newell Drive, Gainesville, FL 32611 USA
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Morishita T, Fayad SM, Goodman WK, Foote KD, Chen D, Peace DA, Rhoton AL, Okun MS. Surgical neuroanatomy and programming in deep brain stimulation for obsessive compulsive disorder. Neuromodulation 2013; 17:312-9; discussion 319. [PMID: 24345303 DOI: 10.1111/ner.12141] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 10/06/2013] [Accepted: 10/31/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Deep brain stimulation (DBS) has been established as a safe, effective therapy for movement disorders (Parkinson's disease, essential tremor, etc.), and its application is expanding to the treatment of other intractable neuropsychiatric disorders including depression and obsessive-compulsive disorder (OCD). Several published studies have supported the efficacy of DBS for severely debilitating OCD. However, questions remain regarding the optimal anatomic target and the lack of a bedside programming paradigm for OCD DBS. Management of OCD DBS can be highly variable and is typically guided by each center's individual expertise. In this paper, we review the various approaches to targeting and programming for OCD DBS. We also review the clinical experience for each proposed target and discuss the relevant neuroanatomy. MATERIALS AND METHODS A PubMed review was performed searching for literature on OCD DBS and included all articles published before March 2012. We included all available studies with a clear description of the anatomic targets, programming details, and the outcomes. RESULTS Six different DBS approaches were identified. High-frequency stimulation with high voltage was applied in most cases, and predictive factors for favorable outcomes were discussed in the literature. CONCLUSION DBS remains an experimental treatment for medication refractory OCD. Target selection and programming paradigms are not yet standardized, though an improved understanding of the relationship between the DBS lead and the surrounding neuroanatomic structures will aid in the selection of targets and the approach to programming. We propose to form a registry to track OCD DBS cases for future clinical study design.
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Affiliation(s)
- Takashi Morishita
- Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA
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28
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Deep Brain Stimulation in the Treatment of Obsessive-Compulsive Disorder. World Neurosurg 2013; 80:e245-53. [DOI: 10.1016/j.wneu.2012.10.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 10/02/2012] [Indexed: 11/21/2022]
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Höflich A, Savli M, Comasco E, Moser U, Novak K, Kasper S, Lanzenberger R. Neuropsychiatric deep brain stimulation for translational neuroimaging. Neuroimage 2013; 79:30-41. [DOI: 10.1016/j.neuroimage.2013.04.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 04/13/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022] Open
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30
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Cognitive Functioning in Psychiatric Disorders Following Deep Brain Stimulation. Brain Stimul 2013; 6:532-7. [DOI: 10.1016/j.brs.2013.01.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 12/18/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022] Open
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31
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Taghva A, Oluigbo C, Corrigan J, Rezai AR. Posttraumatic stress disorder: neurocircuitry and implications for potential deep brain stimulation. Stereotact Funct Neurosurg 2013; 91:207-19. [PMID: 23548850 DOI: 10.1159/000343148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 09/04/2012] [Indexed: 11/19/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a prevalent and highly disabling psychiatric disorder that is notoriously difficult to treat. At some point in their lifetimes, 5-8% of men, 10-14% of women, and up to a quarter of combat veterans carry this diagnosis. Despite pharmacological and behavioral therapies, up to 30% of patients are still symptomatic 10 years after initial diagnosis. Recent advances in imaging have implicated changes in the limbic and autonomic corticostriatopallidothalamocortical (CSPTC) circuitry in the pathogenesis of this disease. Deep brain stimulation modulates CSPTC circuits in movement and other neuropsychiatric disorders. In this review, we discuss the salient clinical features and neurocircuitry of PTSD and propose a neuromodulation strategy for the disorder.
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Affiliation(s)
- Alexander Taghva
- Center for Neuromodulation, Department of Neurosurgery, Ohio State University, Columbus, Ohio, USA.
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32
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Taghva A, Corrigan JD, Rezai AR. Obesity and brain addiction circuitry: implications for deep brain stimulation. Neurosurgery 2013; 71:224-38. [PMID: 22513843 DOI: 10.1227/neu.0b013e31825972ab] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Obesity is a growing health problem worldwide and is responsible for a significant proportion of health expenditures in developed nations. It is also notoriously difficult to treat. Prior attempts at pharmacological or neurological modulation, including deep brain stimulation, have primarily targeted homeostatic mechanisms of weight control centered in the hypothalamus. To date, these attempts have had limited success. Multiple lines of independent data suggest that dysregulated reward circuitry in the brain underlies behaviors leading to obesity. Here, we review the existing data and related neurocircuitry, as well as the scope of obesity and currently available treatments. Finally, we suggest a neuromodulation strategy geared toward regulating these dysfunctional circuits, primarily by alteration of frontolimbic circuits.
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Affiliation(s)
- Alexander Taghva
- Ohio State University Medical Center, Department of Neurosurgery, Center for Neuromodulation, Columbus, Ohio, USA.
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33
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Deep brain stimulation for treatment-resistant depression. World Neurosurg 2012; 80:S27.e17-24. [PMID: 23111230 DOI: 10.1016/j.wneu.2012.10.068] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 09/22/2012] [Accepted: 10/23/2012] [Indexed: 01/24/2023]
Abstract
BACKGROUND Major depressive disorder is a common and disabling illness and is the leading cause of disability worldwide. Despite aggressive medical, behavioral, and electroconvulsive therapies, a significant number of patients remain refractory to treatment. Deep brain stimulation (DBS) has proven efficacy in neurobehavioral disorders and, in a general sense, works by modulation of corticostriatopallidothalamocortical circuits implicated in these disorders. METHODS Current data, treatment rationales, and future directions are presented. RESULTS The two targets most commonly used for DBS in treatment-resistant depression are the subgenual cingulate gyrus and the ventral capsule/ventral striatum. Data on DBS of these regions are preliminary, with promise shown in early studies. CONCLUSIONS Early work suggests DBS may become a therapeutic option in treatment-resistant depression. Further study is justified given the immense burden of disease.
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Yeremeyeva E, Taghva A, Rezai AR. Seeking new solutions: stimulation of diseased circuits in depression and other neurobehavioral disorders. Neurosurgery 2012; 59:44-9. [PMID: 22960512 DOI: 10.1227/neu.0b013e31826989da] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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35
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Albelda N, Joel D. Current animal models of obsessive compulsive disorder: an update. Neuroscience 2012; 211:83-106. [PMID: 21925243 DOI: 10.1016/j.neuroscience.2011.08.070] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 08/29/2011] [Accepted: 08/31/2011] [Indexed: 12/30/2022]
Affiliation(s)
- N Albelda
- Department of Psychology, Tel Aviv University, Ramat-Aviv, Tel Aviv 69978, Israel
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36
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Mohr P, Rodriguez M, Slavíčková A, Hanka J. The application of vagus nerve stimulation and deep brain stimulation in depression. Neuropsychobiology 2011; 64:170-81. [PMID: 21811087 DOI: 10.1159/000325225] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 01/23/2011] [Indexed: 01/24/2023]
Abstract
Despite the progress in the pharmacotherapy of depression, there is a substantial proportion of treatment-resistant patients. Recently, reversible invasive stimulation methods, i.e. vagus nerve stimulation (VNS) and deep brain stimulation (DBS), have been introduced into the management of treatment-resistant depression (TRD). VNS has already received regulatory approval for TRD. This paper reviews the available clinical evidence and neurobiology of VNS and DBS in TRD. The principle of VNS is a stimulation of the left cervical vagus nerve with a programmable neurostimulator. VNS was examined in 4 clinical trials with 355 patients. VNS demonstrated steadily increasing improvement with full benefit after 6-12 months, sustained up to 2 years. Patients who responded best had a low-to-moderate antidepressant resistance. However, the primary results of the only controlled trial were negative. DBS involves stereotactical implantation of electrodes powered by a pulse generator into the specific brain regions. For depression, the targeted areas are the subthalamic nucleus, internal globus pallidus, ventral internal capsule/ventral striatum, the subgenual cingulated region, and the nucleus accumbens. Antidepressant effects of DBS were examined in case series with a total number of 50 TRD patients. Stimulation of different brain regions resulted in a reduction of depressive symptoms. The clinical data on the use of VNS and DBS in TRD are encouraging. The major contribution of the methods is a novel approach that allows for precise targeting of the specific brain areas, nuclei and circuits implicated in the etiopathogenesis of neuropsychiatric disorders. For clinical practice, it is necessary to identify patients who may best benefit from VNS or DBS.
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Affiliation(s)
- Pavel Mohr
- Prague Psychiatric Center, Charles University Prague, Prague, Czech Republic.
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37
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Abstract
The phenomenon of treatment-resistant depression (TRD), described as the occurrence of an inadequate response after an adequate treatment with antidepressant agents (in terms of dose, duration, and adherence), is very common in clinical practice. It has been broadly defined in the context of unipolar major depression, but alternative definitions for bipolar depression have also been suggested. In both cases, there is a remarkable lack of consensus amongst professionals concerning its operative definition. A relatively wide variety of treatment options for unipolar TRD are available, whilst the evidence is very scanty for bipolar TRD. TRD is associated to poor clinical, functional, and social outcomes. Several novel therapeutic options are currently being investigated as promising alternatives, targeting the neurotransmitter system outside of the standard monoamine hypothesis. Augmentation or combination with lithium or atypical antipsychotics appears as a valid option for both conditions, and the same occurs with electroconvulsive therapy. Other non-pharmacological strategies such as deep brain stimulation may be promising alternatives for the future. The use of cognitive behaviour therapy is recommended for unipolar TRD, but there is no evidence supporting its use in bipolar TRD.
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Affiliation(s)
- Eduard Vieta
- Bipolar Disorders Program, Hospital Clinic, University of Barcelona , Catalonia, Spain.
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38
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Barbas H, Zikopoulos B, Timbie C. Sensory pathways and emotional context for action in primate prefrontal cortex. Biol Psychiatry 2011; 69:1133-9. [PMID: 20889144 DOI: 10.1016/j.biopsych.2010.08.008] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 08/11/2010] [Accepted: 08/13/2010] [Indexed: 11/28/2022]
Abstract
Connections of the primate prefrontal cortex are associated with action. Within the lateral prefrontal cortex, there are preferential targets of projections from visual, auditory, and somatosensory cortices associated with directing attention to relevant stimuli and monitoring responses for specific tasks. Return pathways from lateral prefrontal areas to sensory association cortices suggest a role in selecting relevant stimuli and suppressing distracters to accomplish specific tasks. Projections from sensory association cortices to orbitofrontal cortex are more global than to lateral prefrontal areas, especially for posterior orbitofrontal cortex (pOFC), which is connected with sensory association cortices representing each sensory modality and with structures associated with the internal, or emotional, environment. A specialized projection from pOFC to the intercalated masses of the amygdala is poised to flexibly affect autonomic responses in emotional arousal or return to homeostasis. The amygdala projects to the magnocellular mediodorsal thalamic nucleus, which projects most robustly to pOFC among prefrontal cortices, suggesting sequential processing for emotions. The specialized connections of pOFC distinguish it as a separate orbitofrontal region that may function as the primary sensor of information for emotions. Lateral prefrontal areas 46 and 9 and the pOFC send widespread projections to the inhibitory thalamic reticular nucleus, suggesting a role in gating sensory and motivationally salient signals and suppressing distracters at an early stage of processing. Intrinsic connections link prefrontal areas, enabling synthesis of sensory information and emotional context for selective attention and action, in processes that are disrupted in psychiatric disorders, including attention-deficit/hyperactivity disorder.
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Affiliation(s)
- Helen Barbas
- Neural Systems Laboratory, Boston University and School of Medicine, Boston, MA 02215, USA.
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39
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Albelda N, Joel D. Animal models of obsessive-compulsive disorder: exploring pharmacology and neural substrates. Neurosci Biobehav Rev 2011; 36:47-63. [PMID: 21527287 DOI: 10.1016/j.neubiorev.2011.04.006] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Revised: 04/05/2011] [Accepted: 04/08/2011] [Indexed: 01/07/2023]
Abstract
During the last 30 years there have been many attempts to develop animal models of obsessive-compulsive disorder (OCD). Most models have not been studied further following the original publication, and in the past few years, most papers present studies employing a few established animal models, exploring the neural basis of compulsive behavior and developing new treatment strategies. Here we summarize findings from the five most studied animal models of OCD: 8-OHDPAT (8-hydroxy-2-(di-n-propylamino)-tetralin hydrobromide) induced decreased alternation, quinpirole-induced compulsive checking, marble burying, signal attenuation and spontaneous stereotypy in deer mice. We evaluate each model's face validity, derived from similarity between the behavior in the model and the specific symptoms of the human condition, predictive validity, derived from similarity in response to treatment (pharmacological or other), and construct validity, derived from similarity in the mechanism (physiological or psychological) that induces behavioral symptoms and in the neural systems involved. We present ideas regarding future clinical research based on each model's findings, and on this basis, also emphasize possible new approaches for the treatment of OCD.
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Affiliation(s)
- Noa Albelda
- Department of Psychology, Tel Aviv University, Ramat-Aviv, Tel Aviv 69978, Israel
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40
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Encinas JM, Hamani C, Lozano AM, Enikolopov G. Neurogenic hippocampal targets of deep brain stimulation. J Comp Neurol 2011; 519:6-20. [PMID: 21120924 DOI: 10.1002/cne.22503] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Deep brain stimulation (DBS) is being used to treat movement, neurological, and psychiatric disorders; recently it has been successfully applied to patients with treatment-resistant depression or in minimally conscious state. In addition to its clinical importance, DBS presents a powerful approach to target specific neural circuits and determine the functional relationship between the components of these circuits. We examined the effect of high-frequency stimulation of a crucial component of the limbic circuitry, the anterior thalamic nuclei (ATN), on the generation of new neurons in the dentate gyrus (DG) of the hippocampus, another component of the same circuitry. Adult hippocampal neurogenesis emerges as a strong correlate of antidepressant treatments; however, in most cases, the progenitor cell population targeted by a specific treatment is not known. Using reporter mouse lines designed to quantify changes in selected classes of neural progenitors, we found that high-frequency stimulation of the ATN increases symmetric divisions of a defined class of neural progenitors in the DG; this effect is later manifested as an increased number of new neurons. The affected class of neural progenitors is also affected by the antidepressant fluoxetine (Prozac) and physical exercise (running). This indicates that neurogenic stimuli of different natures can converge on the same neurogenic target in the DG. Our results also suggest that hippocampal neurogenesis may be used as a sensitive indicator of the limbic circuitry activation induced by DBS.
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Affiliation(s)
- Juan M Encinas
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York 11724, USA
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41
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Hamani C, Nóbrega JN. Deep brain stimulation in clinical trials and animal models of depression. Eur J Neurosci 2011; 32:1109-17. [PMID: 21039950 DOI: 10.1111/j.1460-9568.2010.07414.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Deep brain stimulation (DBS) is currently being investigated as a therapy for the treatment of depression. Despite promising results of recent clinical trials, neural and chemical mechanisms responsible for the effects of stimulation are still unclear. In this article, we review clinical and laboratory findings on DBS for depression. Particular emphasis will be given to aspects involved in the translation of data from animal models to humans and in our findings on the potential substrates involved in the antidepressant effects of DBS in rats.
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Affiliation(s)
- Clement Hamani
- Neuroimaging Research Section, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada.
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42
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Blomstedt P, Sjöberg RL, Hansson M, Bodlund O, Hariz MI. Deep brain stimulation in the treatment of depression. Acta Psychiatr Scand 2011; 123:4-11. [PMID: 20961293 DOI: 10.1111/j.1600-0447.2010.01625.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To present the technique of deep brain stimulation (DBS) and to evaluate the studies conducted on DBS in the treatment of therapy-refractory major depressive disorder (MDD). METHOD A review of the literature on DBS in the treatment of MDD was conducted. RESULTS The results of DBS in MDD have been presented in 2 case reports and 3 studies of 47 patients operated upon in 5 different target areas. Positive effects have been presented in all studies and side effects have been minor. DBS in the nucleus accumbens resulted in a mean reduction of Hamilton depression rating scale (HDRS) of 36% after 1 year and 30% of the 10 patients achieved remission. DBS in the internal capsule/ventral striatum resulted in a reduction of 44% after 1 year, and at the last evaluation after in mean 2 years, 40% of the 15 patients were in remission. The 20 patients with subcallosal cingulated gyrus DBS had a reduction of HDRS of 52% after 1 year, and 35% were within 1 point from remission or in remission. CONCLUSION DBS is a promising treatment for therapy-refractory MDD. The published experience is, however, limited, and the method is at present an experimental therapy.
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Affiliation(s)
- P Blomstedt
- Department of Neurosurgery, University Hospital of Umeå, Sweden.
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43
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Figee M, Mantione M, van den Munckhof P, Schuurman R, Denys D. Targets for Deep Brain Stimulation in Obsessive-Compulsive Disorder. Psychiatr Ann 2010. [DOI: 10.3928/00485713-20100924-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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44
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Mian MK, Campos M, Sheth SA, Eskandar EN. Deep brain stimulation for obsessive-compulsive disorder: past, present, and future. Neurosurg Focus 2010; 29:E10. [DOI: 10.3171/2010.4.focus10107] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a psychiatric illness that can lead to chronic functional impairment. Some patients with severe, chronic OCD have been treated with ablative neurosurgical techniques over the past 4 decades. More recently, deep brain stimulation (DBS) has been investigated as a therapy for refractory OCD, and the procedure was granted a limited humanitarian device exemption by the FDA in 2009. In this article, the authors review the development of DBS for OCD, describe the current understanding of the pathophysiological mechanisms of the disorder and how the underlying neural circuits might be modulated by DBS, and discuss the clinical studies that provide evidence for the use of this evolving therapy. The authors conclude with suggestions for how a combined basic science and translational research approach could drive the understanding of the neural mechanisms underlying OCD as well as the clinical effectiveness of DBS in the setting of recalcitrant disease.
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Affiliation(s)
- Matthew K. Mian
- 1Department of Neurosurgery, Massachusetts General Hospital; and
- 2Harvard Medical School, Boston, Massachusetts
| | - Michael Campos
- 1Department of Neurosurgery, Massachusetts General Hospital; and
- 2Harvard Medical School, Boston, Massachusetts
| | - Sameer A. Sheth
- 1Department of Neurosurgery, Massachusetts General Hospital; and
| | - Emad N. Eskandar
- 1Department of Neurosurgery, Massachusetts General Hospital; and
- 2Harvard Medical School, Boston, Massachusetts
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45
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Update on deep brain stimulation for neuropsychiatric disorders. Neurobiol Dis 2010; 38:346-53. [PMID: 20096357 DOI: 10.1016/j.nbd.2010.01.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 09/16/2009] [Accepted: 01/14/2010] [Indexed: 11/18/2022] Open
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46
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Lakhan SE, Callaway E. Deep brain stimulation for obsessive-compulsive disorder and treatment-resistant depression: systematic review. BMC Res Notes 2010; 3:60. [PMID: 20202203 PMCID: PMC2838907 DOI: 10.1186/1756-0500-3-60] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 03/04/2010] [Indexed: 12/04/2022] Open
Abstract
Background In spite of advances in psychotherapy and pharmacotherapy, there are still a significant number of patients with depression and obsessive-compulsive disorder that are not aided by either intervention. Although still in the experimental stage, deep brain stimulation (DBS) offers many advantages over other physically-invasive procedures as a treatment for these psychiatric disorders. The purpose of this study is to systematically review reports on clinical trials of DBS for obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD). Locations for stimulation, success rates and effects of the stimulation on brain metabolism are noted when available. The first observation of the effects of DBS on OCD and TRD came in the course of using DBS to treat movement disorders. Reports of changes in OCD and depression during such studies are reviewed with particular attention to electrode locations and associated adverse events; although these reports were adventitious observations rather than planned. Subsequent studies have been guided by more precise theories of structures involved in DBS and OICD. This study suggests stimulation sites and prognostic indicators for DBS. We also briefly review tractography, a relatively new procedure that holds great promise for the further development of DBS. Methods Articles were retrieved from MEDLINE via PubMed. Relevant references in retrieved articles were followed up. We included all articles reporting on studies of patients selected for having OCD or TRD. Adequacy of the selected studies was evaluated by the Jadad scale. Evaluation criteria included: number of patients, use of recognized psychiatric rating scales, and use of brain blood flow measurements. Success rates classified as "improved" or "recovered" were recorded. Studies of DBS for movement disorders were included if they reported coincidental relief of depression or reduction in OCD. Most of the studies involved small numbers of subjects so individual studies were reviewed. Results While the number of cases was small, these were extremely treatment-resistant patients. While not everyone responded, about half the patients did show dramatic improvement. Associated adverse events were generally trivial in younger psychiatric patients but often severe in older movement disorder patients. The procedures differed from study to study, and the numbers of patients was usually too small to do meaningful statistics or make valid inferences as to who will respond to treatment. Conclusions DBS is considered a promising technique for OCD and TRD. Outstanding questions about patient selection and electrode placement can probably be resolved by (a) larger studies, (b) genetic studies and (c) imaging studies (MRI, fMRI, PET, and tractography).
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Affiliation(s)
- Shaheen E Lakhan
- Global Neuroscience Initiative Foundation, Los Angeles, CA, USA.
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Kuhn J, Gründler TOJ, Lenartz D, Sturm V, Klosterkötter J, Huff W. Deep brain stimulation for psychiatric disorders. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:105-13. [PMID: 20221269 DOI: 10.3238/arztebl.2010.0105] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 08/27/2009] [Indexed: 01/24/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS), an established treatment for some movement disorders, is now being used experimentally to treat psychiatric disorders as well. In a number of recently published case series, DBS yielded an impressive therapeutic benefit in patients with medically intractable psychiatric diseases. METHODS This review of the use of DBS to treat psychiatric disorders is based on literature retrieved from a selective Pubmed search for relevant keywords, reference works on the topic, and the authors' own research. RESULTS Studies have been performed on the use of DBS to treat medically intractable obsessive-compulsive disorder, depressive disorders, and Tourette syndrome. The case numbers in the cited publications were small, yet at least some of them involved a methodologically sound investigation. Thus, in some studies, the strength of the effect was controlled with a double-blinded interval in which the stimulation was turned off. In general, the primary symptoms were found to improve markedly, by 35% to 70%, although not all patients responded to the treatment. Adverse effects of DBS were very rare in most studies and could usually be reversed by changing the stimulation parameters. CONCLUSIONS The results of DBS for psychiatric disorders that have been published to date are encouraging. They open up a new perspective in the treatment of otherwise intractable disorders. Nonetheless, the efficacy, mechanism of action, and adverse effects of DBS for this indication still need to be further studied in methodologically adequate trials that meet the highest ethical standard.
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Affiliation(s)
- Jens Kuhn
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität zu Köln, Germany.
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Andrade P, Fernández-Guasti A, Carrillo-Ruiz JD, Ulloa RE, Ramírez Y, Reyes R, Jiménez F. Effects of bilateral lesions in thalamic reticular nucleus and orbitofrontal cortex in a T-maze perseverative model produced by 8-OH-DPAT in rats. Behav Brain Res 2009; 203:108-12. [DOI: 10.1016/j.bbr.2009.04.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 04/10/2009] [Accepted: 04/20/2009] [Indexed: 11/26/2022]
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Jaafari N, Giré P, Houeto JL. Stimulation cérébrale profonde, maladie de Parkinson et complications neuropsychiatriques. Presse Med 2009; 38:1335-42. [DOI: 10.1016/j.lpm.2008.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 10/29/2008] [Accepted: 11/05/2008] [Indexed: 01/14/2023] Open
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Andrade P, Carrillo-Ruiz JD, Ramírez Y, Jiménez F. Effects of Thalamic Reticular Nucleus Electrical Stimulation in Rats in a T-maze Perseverative Behavior Model Induced by 8-OH-DPAT. Neuromodulation 2009; 13:2-9. [DOI: 10.1111/j.1525-1403.2009.00242.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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