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Deep brain stimulation of the subthalamic nucleus to improve symptoms and cognitive functions in patients with refractory obsessive-compulsive disorder: a longitudinal study. Neurol Sci 2023:10.1007/s10072-023-06614-1. [PMID: 36849693 DOI: 10.1007/s10072-023-06614-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/10/2023] [Indexed: 03/01/2023]
Abstract
There are conflicting results regarding the effect of deep brain stimulation (DBS) of different regions on the cognitive functions of patients with severe refractory obsessive-compulsive disorder (OCD). Moreover, it is not yet clear whether the rate of improvement in obsession-compulsion symptoms and cognitive functions following DBS is interrelated. We investigated the effect of the subthalamic nucleus (STN)-DBS on both the severity of symptoms and cognitive functions of patients and also investigated the possible interrelationship between the two. Twelve patients (10 males and two females; 56.17 ± 4.52 years old) were assessed before and 1 month and 3 months after the DBS surgery using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the N-Back, the selective and divided attention (SDA), the Tower of London (TOL), and the Wisconsin Card Sorting (WCS) tests. We found that the severity of symptoms and cognitive functions improved significantly after DBS and this effect lasted at least up to 3 months. Furthermore, it was revealed that the severity of symptoms and cognitive profiles of patients were significantly correlated. Compulsion severity had the highest correlation with perseveration errors, while obsession severity was most correlated with the number of n-back errors. Based on our findings, it seems that the STN acts at least to some extent as a common functional/anatomical ground for the severity of symptoms and cognitive functions of patients with severe refractory OCD, and it can probably be considered as the region of interest for DBS in this group of patients.
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2
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Miletić S, Keuken MC, Mulder M, Trampel R, de Hollander G, Forstmann BU. 7T functional MRI finds no evidence for distinct functional subregions in the subthalamic nucleus during a speeded decision-making task. Cortex 2022; 155:162-188. [DOI: 10.1016/j.cortex.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/18/2022] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
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Torres Díaz CV, Treu S, Strange B, Lara M, Navas M, Ezquiaga E, Zazo ES, Vicente JS, Muñiz I, Fernandez FS. Deep Brain Stimulation of the Nucleus Accumbens, Ventral Striatum, or Internal Capsule Targets for Medication-Resistant Obsessive-Compulsive Disorder: A Multicenter Study. World Neurosurg 2021; 155:e168-e176. [PMID: 34403796 DOI: 10.1016/j.wneu.2021.08.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Deep brain stimulation of the nucleus accumbens, ventral striatum, or internal capsule region has shown a 45%-60% response rate in adults with severe treatment-refractory obsessive-compulsive disorder, regardless of which target is used. We sought to improve the effectiveness of deep brain stimulation by placing the electrode along a trajectory including these 3 targets, enabling a change of stimulation site depending on the patient's response. METHODS This study used the medical records of 14 patients from 4 different Spanish institutions: 7 from the Hospital Universitario La Princesa, 3 from the Hospital Universitario Central de Asturias, 2 from Hospital Universitario Fundación Jiménez Díaz, and 2 from Hospital Universitari Son Espases. All patients were operated on under the same protocol. Qualitative and quantitative data were collected. RESULTS Of 14 patients, 11 showed significant improvement in obsessive-compulsive disorder symptoms, as evident in a reduction ≥35% in Yale-Brown Obsessive Compulsive Scale scores following stimulation relative to preoperative scores. Seven patients responded to stimulation at the nucleus accumbens (the first area we set for stimulation), whereas 4 patients needed to have the active contact switched to the internal capsule to benefit from stimulation. CONCLUSIONS Deep brain stimulation of the nucleus accumbens, internal capsule, and ventral striatum significantly benefited our cohort of patients with medication-resistant obsessive-compulsive disorder. Electrode insertion through the 3 main targets might confer additional therapeutic efficacy.
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Affiliation(s)
- Cristina V Torres Díaz
- Department of Neurourgery, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Svenja Treu
- Laboratory for Clinical Neuroscience, Centre of Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | - Bryan Strange
- Laboratory for Clinical Neuroscience, Centre of Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | - Monica Lara
- Department of Neurosurgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Marta Navas
- Department of Neurourgery, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Ezquiaga
- Department of Psychiatry, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Elisa Seijo Zazo
- Department of Psychiatry, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Isabel Muñiz
- Department of Psychology, Universidad Anáhuac Cancún, Cancún, Mexico
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Merola A, Singh J, Reeves K, Changizi B, Goetz S, Rossi L, Pallavaram S, Carcieri S, Harel N, Shaikhouni A, Sammartino F, Krishna V, Verhagen L, Dalm B. New Frontiers for Deep Brain Stimulation: Directionality, Sensing Technologies, Remote Programming, Robotic Stereotactic Assistance, Asleep Procedures, and Connectomics. Front Neurol 2021; 12:694747. [PMID: 34367055 PMCID: PMC8340024 DOI: 10.3389/fneur.2021.694747] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
Over the last few years, while expanding its clinical indications from movement disorders to epilepsy and psychiatry, the field of deep brain stimulation (DBS) has seen significant innovations. Hardware developments have introduced directional leads to stimulate specific brain targets and sensing electrodes to determine optimal settings via feedback from local field potentials. In addition, variable-frequency stimulation and asynchronous high-frequency pulse trains have introduced new programming paradigms to efficiently desynchronize pathological neural circuitry and regulate dysfunctional brain networks not responsive to conventional settings. Overall, these innovations have provided clinicians with more anatomically accurate programming and closed-looped feedback to identify optimal strategies for neuromodulation. Simultaneously, software developments have simplified programming algorithms, introduced platforms for DBS remote management via telemedicine, and tools for estimating the volume of tissue activated within and outside the DBS targets. Finally, the surgical accuracy has improved thanks to intraoperative magnetic resonance or computerized tomography guidance, network-based imaging for DBS planning and targeting, and robotic-assisted surgery for ultra-accurate, millimetric lead placement. These technological and imaging advances have collectively optimized DBS outcomes and allowed “asleep” DBS procedures. Still, the short- and long-term outcomes of different implantable devices, surgical techniques, and asleep vs. awake procedures remain to be clarified. This expert review summarizes and critically discusses these recent innovations and their potential impact on the DBS field.
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Affiliation(s)
- Aristide Merola
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Jaysingh Singh
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Kevin Reeves
- Department of Psychiatry, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Barbara Changizi
- Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Steven Goetz
- Medtronic PLC Neuromodulation, Minneapolis, MN, United States
| | | | | | | | - Noam Harel
- Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Ammar Shaikhouni
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Francesco Sammartino
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Vibhor Krishna
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Leo Verhagen
- Movement Disorder Section, Department of Neurological Sciences, Rush University, Chicago, IL, United States
| | - Brian Dalm
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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5
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Rezai AR, Ranjan M, Figee M, Kopell BH. Commentary: Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for Deep Brain Stimulations for Obsessive-Compulsive Disorder: Update of the 2014 Guidelines. Neurosurgery 2021; 88:E554-E555. [PMID: 33733275 DOI: 10.1093/neuros/nyab078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/20/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ali R Rezai
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Manish Ranjan
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Martijn Figee
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Center for Neuromodulation/Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian Harris Kopell
- Center for Neuromodulation/Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Arumugham SS, Srinivas D, Narayanaswamy JC, Jaisoorya TS, Kashyap H, Domenech P, Palfi S, Mallet L, Venkatasubramanian G, Reddy YJ. Identification of biomarkers that predict response to subthalamic nucleus deep brain stimulation in resistant obsessive-compulsive disorder: protocol for an open-label follow-up study. BMJ Open 2021; 11:e047492. [PMID: 34158304 PMCID: PMC8220486 DOI: 10.1136/bmjopen-2020-047492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/26/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) of bilateral anteromedial subthalamic nucleus (amSTN) has been found to be helpful in a subset of patients with severe, chronic and treatment-refractory obsessive-compulsive disorder (OCD). Biomarkers may aid in patient selection and optimisation of this invasive treatment. In this trial, we intend to evaluate neurocognitive function related to STN and related biosignatures as potential biomarkers for STN DBS in OCD. METHODS AND ANALYSIS Twenty-four subjects with treatment-refractory OCD will undergo open-label STN DBS. Structural/functional imaging, electrophysiological recording and neurocognitive assessment would be performed at baseline. The subjects would undergo a structured clinical assessment for 12 months postsurgery. A group of 24 healthy volunteers and 24 subjects with treatment-refractory OCD who receive treatment as usual would be recruited for comparison of biomarkers and treatment response, respectively. Baseline biomarkers would be evaluated as predictors of clinical response. Neuroadaptive changes would be studied through a reassessment of neurocognitive functioning, imaging and electrophysiological activity post DBS. ETHICS AND DISSEMINATION The protocol has been approved by the National Institute of Mental Health and Neurosciences Ethics Committee. The study findings will be disseminated through peer-reviewed scientific journals and scientific meetings.
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Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - T S Jaisoorya
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Himani Kashyap
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Philippe Domenech
- Univ Paris-Est Créteil, DMU CARE - Département Médical-Universitaire de Chirurgie et Anesthésie réanimation, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
- Univ of Paris 12 UPEC, Faculté de médecine, INSERM U955, Creteil, France
| | - Stéphane Palfi
- Univ Paris-Est Créteil, DMU CARE - Département Médical-Universitaire de Chirurgie et Anesthésie réanimation, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
- Univ of Paris 12 UPEC, Faculté de médecine, INSERM U955, Creteil, France
| | - Luc Mallet
- Institut du Cerveau, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Yc Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Lopez-Sosa F, Reneses B, Sanmartino F, Galarza-Vallejo A, Garcia-Albea J, Cruz-Gomez AJ, Yebra M, Oliviero A, Barcia JA, Strange BA, Gonzalez-Rosa JJ. Nucleus Accumbens Stimulation Modulates Inhibitory Control by Right Prefrontal Cortex Activation in Obsessive-Compulsive Disorder. Cereb Cortex 2021; 31:2742-2758. [PMID: 33406245 DOI: 10.1093/cercor/bhaa397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/03/2020] [Accepted: 12/11/2020] [Indexed: 11/14/2022] Open
Abstract
Inhibitory control is considered a compromised cognitive function in obsessive-compulsive (OCD) patients and likely linked to corticostriatal circuitry disturbances. Here, 9 refractory OCD patients treated with deep brain stimulation (DBS) were evaluated to address the dynamic modulations of large-scale cortical network activity involved in inhibitory control after nucleus accumbens (NAc) stimulation and their relationship with cortical thickness. A comparison of DBS "On/Off" states showed that patients committed fewer errors and exhibited increased intraindividual reaction time variability, resulting in improved goal maintenance abilities and proactive inhibitory control. Visual P3 event-related potentials showed increased amplitudes during Go/NoGo performance. Go and NoGo responses increased cortical activation mainly over the right inferior frontal gyrus and medial frontal gyrus, respectively. Moreover, increased cortical activation in these areas was equally associated with a higher cortical thickness within the prefrontal cortex. These results highlight the critical role of NAc DBS for preferentially modulating the neuronal activity underlying sustained speed responses and inhibitory control in OCD patients and show that it is triggered by reorganizing brain functions to the right prefrontal regions, which may depend on the underlying cortical thinning. Our findings provide updated structural and functional evidence that supports critical dopaminergic-mediated frontal-striatal network interactions in OCD.
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Affiliation(s)
- Fernando Lopez-Sosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), 11009 Cádiz, Spain.,Laboratory for Clinical Neuroscience, Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), 28040 Madrid, Spain
| | - Blanca Reneses
- Department of Psychiatry, Health Research Institute of Hospital Clinico San Carlos (IdISSC), Complutense University of Madrid (UCM), 28040 Madrid, Spain
| | | | - Ana Galarza-Vallejo
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), 28040 Madrid, Spain
| | - Julia Garcia-Albea
- Department of Psychiatry, Health Research Institute of Hospital Clinico San Carlos (IdISSC), Complutense University of Madrid (UCM), 28040 Madrid, Spain
| | - Alvaro J Cruz-Gomez
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), 11009 Cádiz, Spain
| | - Mar Yebra
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), 28040 Madrid, Spain.,Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45004 Toledo, Spain
| | - Juan A Barcia
- Department of Neurosurgery, Health Research Institute of Hospital Clinico San Carlos (IdISSC), Complutense University of Madrid (UCM), 28040 Madrid, Spain
| | - Bryan A Strange
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), 28040 Madrid, Spain.,Department of Neuroimaging, Alzheimer's Disease Research Centre, Reina Sofia-CIEN Foundation, 28013 Madrid, Spain
| | - Javier J Gonzalez-Rosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), 11009 Cádiz, Spain.,Laboratory for Clinical Neuroscience, Centre for Biomedical Technology (CTB), Technical University of Madrid (UPM), 28040 Madrid, Spain.,Department of Psychology, University of Cadiz. 11003 Cádiz, Spain
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Abstract
It becomes increasingly clear that (non-)invasive neurostimulation is an effective treatment for obsessive-compulsive disorder (OCD). In this chapter we review the available evidence on techniques and targets, clinical results including a meta-analysis, mechanisms of action, and animal research. We focus on deep brain stimulation (DBS), but also cover non-invasive neurostimulation including transcranial magnetic stimulation (TMS). Data shows that most DBS studies target the ventral capsule/ventral striatum (VC/VS), with an overall 76% response rate in treatment-refractory OCD. Also TMS holds clinical promise. Increased insight in the normalizing effects of neurostimulation on cortico-striatal-thalamic-cortical (CSTC) loops - through neuroimaging and animal research - provides novel opportunities to further optimize treatment strategies. Advancing clinical implementation of neurostimulation techniques is essential to ameliorate the lives of the many treatment-refractory OCD patients.
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Azriel A, Farrand S, Di Biase M, Zalesky A, Lui E, Desmond P, Evans A, Awad M, Moscovici S, Velakoulis D, Bittar RG. Tractography-Guided Deep Brain Stimulation of the Anteromedial Globus Pallidus Internus for Refractory Obsessive-Compulsive Disorder: Case Report. Neurosurgery 2020; 86:E558-E563. [PMID: 31313803 DOI: 10.1093/neuros/nyz285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 05/08/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Obsessive-compulsive disorder (OCD) is a disabling psychiatric disorder, mainly treated with psychotherapy and pharmacotherapy. Surgical intervention may be appropriate for patients with treatment-refractory OCD. Deep brain stimulation (DBS) is an alternative for previously common ablative surgical procedures. Tractography has been proposed as a method for individualizing DBS treatment and may have the potential to improve efficacy. CLINICAL PRESENTATION We present a patient with treatment-refractory OCD previously treated with bilateral leucotomies, who underwent DBS surgery with targeting informed by tractography. Preoperative tractography to identify suitable DBS targets was undertaken. Structural images were also utilized for standard stereotactic surgical planning. The anteromedial globus pallidus internus (amGPi) was chosen as the target bilaterally after consideration of white matter projections to frontal cortical regions and neurosurgical approach. Bilateral amGPi DBS surgery was undertaken without adverse events. At 16-mo follow-up, there was a 48.5% reduction in OCD symptom severity as measured by the Yale-Brown Obsessive Compulsive Scale. CONCLUSION The amGPi can be a successful DBS target for OCD. This is the first known case to report on DBS surgery postleucotomies for OCD and highlights the utility of tractography for surgical planning in OCD.
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Affiliation(s)
- Amit Azriel
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Sarah Farrand
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia
| | - Maria Di Biase
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia.,Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
| | - Elaine Lui
- Department of Radiology and Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Patricia Desmond
- Department of Radiology and Medicine, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Andrew Evans
- Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Mohammed Awad
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Samuel Moscovici
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Dennis Velakoulis
- Neuropsychiatry Unit, Royal Melbourne Hospital, Melbourne, Australia.,Melbourne Neuropsychiatry Centre, University of Melbourne, Melbourne, Australia
| | - Richard G Bittar
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Australia.,Department of Surgery, The University of Melbourne, Melbourne, Australia.,Deakin University, Victoria, Australia.,Precision Brain Spine and Pain Centre, Kew, Victoria, Australia
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Raviv N, Staudt MD, Rock AK, MacDonell J, Slyer J, Pilitsis JG. A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder. Neurosurgery 2020; 87:1098-1110. [PMID: 32615588 DOI: 10.1093/neuros/nyaa249] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/11/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated efficacy in improving symptoms in medically refractory patients. Multiple targets have been investigated. OBJECTIVE To systematically review the current level and quality of evidence supporting OCD-DBS by target region with the goal of establishing a common nomenclature. METHODS A systematic literature review was performed using the PubMed database and a patient/problem, intervention, comparison, outcome search with the terms "DBS" and "OCD." Of 86 eligible articles that underwent full-text review, 28 were included for review. Articles were excluded if the target was not specified, the focus on nonclinical outcomes, the follow-up period shorter than 3 mo, or the sample size smaller than 3 subjects. Level of evidence was assigned according to the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint guideline committee recommendations. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Selected publications included 9 randomized controlled trials, 1 cohort study, 1 case-control study, 1 cross-sectional study, and 16 case series. Striatal region targets such as the anterior limb of the internal capsule, ventral capsule/ventral striatum, and nucleus accumbens were identified, but stereotactic coordinates were similar despite differing structural names. Only 15 of 28 articles included coordinates. CONCLUSION The striatal area is the most commonly targeted region for OCD-DBS. We recommend a common nomenclature based on this review. To move the field forward to individualized therapy, active contact location relative to stereotactic coordinates and patient specific anatomical and clinical variances need to be reported.
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Affiliation(s)
- Nataly Raviv
- Department of Neurosurgery, Albany Medical College, Albany, New York
| | - Michael D Staudt
- Department of Neurosurgery, Albany Medical College, Albany, New York
| | - Andrew K Rock
- Department of Neurosurgery, Albany Medical College, Albany, New York
| | - Jacquelyn MacDonell
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Julia Slyer
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
| | - Julie G Pilitsis
- Department of Neurosurgery, Albany Medical College, Albany, New York.,Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York
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11
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Pol S, Temel Y, Jahanshahi A. A Custom Made Electrode Construct and Reliable Implantation Method That Allows for Long-Term Bilateral Deep Brain Stimulation in Mice. Neuromodulation 2020; 24:212-219. [PMID: 32385967 PMCID: PMC7984026 DOI: 10.1111/ner.13165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 03/20/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022]
Abstract
Objectives The underlying mechanisms behind the therapeutic and side effects of deep brain stimulation (DBS) need further investigation. The utilization of transgenic mouse lines is a suitable approach to better understand the cellular and network effects of DBS. However, not many bilateral DBS studies have been conducted in mice. This might be due to a lack of commercially available bilateral DBS constructs. Materials and Methods We developed an approach to perform repetitive long‐term DBS in freely moving mice. In this study, we implanted an in‐house custom‐made DBS construct containing two bipolar concentric electrodes to target the subthalamic nucleus (STN) bilaterally. Subsequently, we stimulated half of the animals with clinically relevant parameters three to five times a week with a duration of 20 min for ten weeks. Several behavioral tests were conducted of which the open field test (OFT) is shown to validate the reliability of this electrode construct and implantation method. Furthermore, we performed fiber photometry measurements to show the acute effect of STN‐DBS on serotonin network activity in the dorsal raphe nucleus. Results Repetitive DBS and long‐term behavioral testing were performed without complications. STN‐DBS resulted in an increase of the distance traveled in the OFT and a reduction of calcium levels in serotonergic neurons of the dorsal raphe nucleus. None of the mice had lost their electrodes and postmortem evaluation of the tissue showed accurate targeting of the STN without excessive gliosis. Conclusion The DBS electrode construct and implantation method described can be used for long‐term DBS studies to further investigate the mechanisms underlying DBS.
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Affiliation(s)
- Sylvana Pol
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ali Jahanshahi
- Department of Neuroscience, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
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12
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Vicheva P, Butler M, Shotbolt P. Deep brain stimulation for obsessive-compulsive disorder: A systematic review of randomised controlled trials. Neurosci Biobehav Rev 2020; 109:129-138. [PMID: 31923474 DOI: 10.1016/j.neubiorev.2020.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/22/2019] [Accepted: 01/06/2020] [Indexed: 12/26/2022]
Abstract
Deep brain stimulation (DBS) is considered a promising intervention for treatment-resistant obsessive-compulsive disorder (trOCD). We conducted a systematic search to investigate the efficacy and safety of DBS for OCD. Primary outcomes included the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), adverse events (AE), and quality of life. We assessed affective state, global functioning, cognition, and tolerability as secondary outcomes. Eight studies comprising 80 patients with trOCD were analysed both individually and collectively. We found a pooled mean reduction in Y-BOCS of 38.68 %, indicating DBS could be considered an effective therapy for trOCD. Most AE were mild and transient, however there were five severe surgery-related AE: intracerebral haemorrhage in three patients and infection in two. Mood-related serious AE were one completed suicide, three suicide attempts in two patients, and suicidal thoughts and depression in four. Despite this, affective state improved following stimulation. Despite being limited by significant heterogeneity across studies, our review has shown DBS to be an effective treatment in otherwise trOCD. There is a need to standardise study methodology in future research.
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Affiliation(s)
- Petya Vicheva
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Matthew Butler
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paul Shotbolt
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Psychiatry, South London and Maudsley NHS Foundation Trust, London, UK
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13
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Neural circuits in goal-directed and habitual behavior: Implications for circuit dysfunction in obsessive-compulsive disorder. Neurochem Int 2019; 129:104464. [DOI: 10.1016/j.neuint.2019.104464] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/11/2019] [Accepted: 05/09/2019] [Indexed: 01/04/2023]
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14
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Siwiec SG, Riemann BC, Lee HJ. Predictors of acute outcomes for intensive residential treatment of obsessive-compulsive disorder. Clin Psychol Psychother 2019; 26:661-672. [PMID: 31273851 DOI: 10.1002/cpp.2389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 06/20/2019] [Accepted: 06/25/2019] [Indexed: 11/09/2022]
Abstract
For those who suffer with chronic and disruptive obsessive-compulsive disorder (OCD), who have not been sufficiently helped by outpatient treatments or medications, intensive residential treatment (IRT) is often the next best treatment option. To date, research of the predictors of treatment outcome in IRT for OCD are mixed and sometimes contradictory. Additionally, although comorbidity is common for patients in this setting, the inclusion of comorbidity as a potential predictor of outcome has been mostly lacking in research to date. The current study aimed to address these issues by utilizing optimal indices of treatment outcomes, while incorporating comorbidity into our analyses, in order to identify the predictors of treatment outcomes in the IRT for OCD setting. To this end, we analysed outcome data from 379 patients receiving IRT for OCD at the Rogers Memorial OCD Center between August 2012, and December 2017. Results indicated that the most important predictor of treatment outcome was obsession severity at admission. Specifically, higher obsession severity at admission predicted poorer treatment outcomes at discharge. Clinical implications and suggestions for future research were discussed in the manuscript.
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Affiliation(s)
- Stephan G Siwiec
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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15
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The effects of deep-brain non-stimulation in severe obsessive-compulsive disorder: an individual patient data meta-analysis. Transl Psychiatry 2019; 9:183. [PMID: 31383848 PMCID: PMC6683131 DOI: 10.1038/s41398-019-0522-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/28/2019] [Accepted: 06/20/2019] [Indexed: 01/13/2023] Open
Abstract
Non-intervention-related effects have long been recognized in an array of medical interventions, to which surgical procedures like deep-brain stimulation are no exception. While the existence of placebo and micro-lesion effects has been convincingly demonstrated in DBS for major depression and Parkinson's disease, systematic investigations for obsessive-compulsive disorder (OCD) are currently lacking. We therefore undertook an individual patient data meta-analysis with the aim of quantifying the effect of DBS for severe, treatment-resistant OCD that is not due to the electrical stimulation of brain tissue. The MEDLINE/PubMed database was searched for double-blind, sham-controlled randomized clinical trials published in English between 1998 and 2018. Individual patient data was obtained from the original authors and combined in a meta-analysis. We assessed differences from baseline in obsessive-compulsive symptoms following sham treatment, as measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Four studies met the inclusion criteria, randomizing 49 patients to two periods of active or sham stimulation. To preclude confounding by period effects, our estimate was based only on data from those patients who underwent sham stimulation first (n = 24). We found that sham stimulation induced a significant change in the Y-BOCS score (t = -3.15, P < 0.005), lowering it by 4.9 ± 1.6 points [95% CI = (-8.0, -1.8)]. We conclude that non-stimulation-related effects of DBS exist also in OCD. The identification of the factors determining the magnitude and occurrence of these effects will help to design strategies that will ultimately lead to a betterment of future randomized clinical trials.
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16
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Macpherson T, Hikida T. Role of basal ganglia neurocircuitry in the pathology of psychiatric disorders. Psychiatry Clin Neurosci 2019; 73:289-301. [PMID: 30734985 DOI: 10.1111/pcn.12830] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/22/2019] [Accepted: 02/05/2019] [Indexed: 12/21/2022]
Abstract
Over the last few decades, advances in human and animal-based techniques have greatly enhanced our understanding of the neural mechanisms underlying psychiatric disorders. Many of these studies have indicated connectivity between and alterations within basal ganglia structures to be particularly pertinent to the development of symptoms associated with several of these disorders. Here we summarize the connectivity, molecular composition, and function of sites within basal ganglia neurocircuits. Then we review the current literature from both human and animal studies concerning altered basal ganglia function in five common psychiatric disorders: obsessive-compulsive disorder, substance-related and addiction disorders, major depressive disorder, generalized anxiety disorder, and schizophrenia. Finally, we present a model based upon the findings of these studies that highlights the striatum as a particularly attractive target for restoring normal function to basal ganglia neurocircuits altered within psychiatric disorder patients.
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Affiliation(s)
- Tom Macpherson
- Laboratory for Advanced Brain Functions, Institute for Protein Research, Osaka University, Osaka, Japan
| | - Takatoshi Hikida
- Laboratory for Advanced Brain Functions, Institute for Protein Research, Osaka University, Osaka, Japan
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17
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Cao C, Huang P, Wang T, Zhan S, Liu W, Pan Y, Wu Y, Li H, Sun B, Li D, Litvak V. Cortico-subthalamic Coherence in a Patient With Dystonia Induced by Chorea-Acanthocytosis: A Case Report. Front Hum Neurosci 2019; 13:163. [PMID: 31191273 PMCID: PMC6548057 DOI: 10.3389/fnhum.2019.00163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/03/2019] [Indexed: 02/01/2023] Open
Abstract
The subthalamic nucleus (STN) is a common target for deep brain stimulation (DBS) treatment in Parkinson's disease (PD) but much less frequently targeted for other disorders. Here we report the results of simultaneous local field potential (LFP) recordings and magnetoencephalography (MEG) in a single patient who was implanted bilaterally in the STN for the treatment of dystonia induced by chorea-acanthocytosis. Consistent with the previous results in PD, the dystonia patient showed significant subthalamo-cortical coherence in the high beta band (28-35 Hz) on both sides localized to the mesial sensorimotor areas. In addition, on the right side, significant coherence was found in the theta-alpha band (4-12 Hz) that localized to the medial prefrontal cortex with the peak in the anterior cingulate gyrus. Comparison of STN power spectra with a previously reported PD cohort showed increased power in the theta and alpha bands and decreased power in the low beta band in dystonia which is consistent with most of the previous studies. The present report extends the range of disorders for which cortico-subthalamic oscillatory connectivity has been characterized. Our results strengthen the evidence that at least some of the subthalamo-cortical oscillatory coherent networks are a feature of the healthy brain, although we do not rule out that coherence magnitude could be affected by disease.
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Affiliation(s)
- Chunyan Cao
- Department of Functional Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Peng Huang
- Department of Functional Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Tao Wang
- Department of Functional Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Shikun Zhan
- Department of Functional Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Wei Liu
- Department of Functional Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Yixin Pan
- Department of Functional Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Yiwen Wu
- Department of Neurology, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Hongxia Li
- Department of Neurology, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Bomin Sun
- Department of Functional Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Dianyou Li
- Department of Functional Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Vladimir Litvak
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom
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18
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Calzà J, Gürsel DA, Schmitz-Koep B, Bremer B, Reinholz L, Berberich G, Koch K. Altered Cortico-Striatal Functional Connectivity During Resting State in Obsessive-Compulsive Disorder. Front Psychiatry 2019; 10:319. [PMID: 31133898 PMCID: PMC6524661 DOI: 10.3389/fpsyt.2019.00319] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/24/2019] [Indexed: 01/30/2023] Open
Abstract
Background: Neuroimaging studies show that obsessive-compulsive disorder (OCD) is characterized by an alteration of the cortico-striato-thalamo-cortical (CSTC) system in terms of an imbalance of activity between the direct and the indirect loop of the CSTC. As resting-state functional connectivity (FC) studies investigated only specific parts of the CSTC in patients with OCD up to now, the present study aimed at exploring FC in the CSTC as a whole. Methods: We investigated potential alterations in resting-state FC within the CSTC system in 44 OCD patients and 40 healthy controls by taking into consideration all relevant nodes of the direct and indirect CSTC loop. Results: Compared to healthy controls, OCD patients showed an increased FC between the left subthalamic nucleus (STN) and the left external globus pallidus (GPe), as well as an increased FC between the left GPe and the left internal globus pallidus (GPi). Conclusion: These findings may contribute to a better understanding of the OCD pathophysiology by providing further information on the connectivity alterations within specific regions of the CSTC system. In particular, increased FC between the STN and the left GPe may play a major role in OCD pathology. This assumption is consistent with the fact that these regions are also the main target sites of therapeutic deep brain stimulation in OCD.
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Affiliation(s)
- Jessica Calzà
- Department of Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.,TUM-Neuroimaging Center (TUM-NIC) of Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Deniz A Gürsel
- Department of Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.,TUM-Neuroimaging Center (TUM-NIC) of Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany
| | - Benita Schmitz-Koep
- Department of Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Benno Bremer
- Department of Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Lena Reinholz
- Department of Psychology, Ludwigs-Maximilians-Universität, Munich, Germany
| | - Götz Berberich
- Windach Institute and Hospital of Neurobehavioural Research and Therapy (WINTR), Windach, Germany
| | - Kathrin Koch
- Department of Neuroradiology, Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany.,TUM-Neuroimaging Center (TUM-NIC) of Klinikum rechts der Isar, Technische Universität München (TUM), Munich, Germany.,Graduate School of Systemic Neurosciences GSN, Ludwig-Maximilians-Universität, Biocenter, Munich, Germany
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19
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Barcia JA, Avecillas-Chasín JM, Nombela C, Arza R, García-Albea J, Pineda-Pardo JA, Reneses B, Strange BA. Personalized striatal targets for deep brain stimulation in obsessive-compulsive disorder. Brain Stimul 2018; 12:724-734. [PMID: 30670359 DOI: 10.1016/j.brs.2018.12.226] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 12/05/2018] [Accepted: 12/15/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Psychiatric conditions currently treated with deep brain stimulation (DBS), such as obsessive-compulsive disorder (OCD), are heterogeneous diseases with different symptomatic dimensions, indicating that fixed neuroanatomical DBS targets for all OCD cases may not be efficacious. OBJECTIVE/HYPOTHESIS We tested whether the optimal DBS target for OCD is fixed for all patients or whether it is individualized and related to each patient's symptomatic content. Further, we explored if the optimal target can be predicted by combining functional neuroimaging and structural connectivity. METHODS In a prospective, randomized, double-blinded study in 7 OCD patients, symptomatic content was characterized pre-operatively by clinical interview and OCD symptom-provocation during functional MRI. DBS electrode implantation followed a trajectory placing 4 contacts along a striatal axis (nucleus accumbens to caudate). Patients underwent three-month stimulation periods for each contact (and sham), followed by clinical evaluation. Probabilistic tractography, applied to diffusion-weighted images acquired pre-operatively, was used to study the overlap between projections from the prefrontal areas activated during symptom provocation and the volume of activated tissue of each electrode contact. RESULTS Six patients were classified responders, with median symptomatic reduction of 50% achieved from each patient's best contact. This was located at the caudate in 4 cases and at the accumbens in 2. Critically, the anatomical locus of the best contact (accumbens or caudate) was related to an index derived by combining functional MRI responses to prevailing symptom provocation and prefronto-cortico-striatal projections defined by probabilistic tractography. CONCLUSION Our results therefore represent a step towards personalized, content-specific DBS targets for OCD.
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Affiliation(s)
- Juan A Barcia
- Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain.
| | - Josué M Avecillas-Chasín
- Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Nombela
- Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Rocío Arza
- Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Julia García-Albea
- Service of Psychiatry, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - José A Pineda-Pardo
- CINAC, HM Puerta del Sur, Hospitales de Madrid, Mostoles, and CEU-San Pablo University, Madrid, Spain
| | - Blanca Reneses
- Service of Psychiatry, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Bryan A Strange
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Universidad Politecnica de Madrid, Spain; Department of Neuroimaging, Reina Sofia Centre for Alzheimer's Disease, Madrid, Spain
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20
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Borders C, Hsu F, Sweidan AJ, Matei ES, Bota RG. Deep brain stimulation for obsessive compulsive disorder: A review of results by anatomical target. Ment Illn 2018; 10:7900. [PMID: 30542526 PMCID: PMC6240923 DOI: 10.4081/mi.2018.7900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/05/2018] [Indexed: 12/23/2022] Open
Abstract
Studies suggest deep brain stimulation (DBS) as a treatment modality for the refractory obsessive-compulsive disorder (OCD). It is unclear where to place the DBS. Various sites are proposed for placement with the ventral capsule/ventral striatum (VC/VS) among the most studied. Herein, we aim to summarize both quantitative Yale-Brown Obsessive-Compulsive Scale (YBOCS) data and qualitative descriptions of the participants' symptoms when given. A literature search conducted via PubMed yielded 32 articles. We sought to apply a standard based on the utilization of YBOCS. This yielded 153 distinct patients. The outcome measure we focused on in this review is the latest YBOCS score reported for each patient/cohort in comparison to the location of the DBS. A total of 32 articles were found in the search results. In total, 153 distinct patients' results were reported in these studies. Across this collection of papers, a total of 9 anatomic structures were targeted. The majority of studies showed a better response at the last time point as compared to the first time point. Most patients had DBS at nucleus accumbens followed by VC/VS and the least patients had DBS at the bilateral superolateral branch of the median forebrain bundle and the bilateral basolateral amygdala. The average YBOCS improvement did not seem to directly correlate with the percentile of patients responding to the intervention. Well-controlled, randomized studies with larger sample sizes with close follow up are needed to provide a more accurate determination for placement of DBS for OCD.
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Affiliation(s)
| | - Frank Hsu
- University of California Irvine, Orange, CA, USA
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21
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Suhas S, Banwari G, Tharayil HM, Karia S, D'Cruz MM, Nagendrappa S, Andrade C. Comments on "Efficacy of Transcranial Direct Current Stimulation in the Treatment: Resistant Patients Who Suffer from Severe Obsessive-compulsive Disorder". Indian J Psychol Med 2018; 40:393-394. [PMID: 30093758 PMCID: PMC6065133 DOI: 10.4103/ijpsym.ijpsym_112_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish Banwari
- Department of Psychiatry, Dr. Ismail Polyclinic and National Medical Center, Dubai, UAE
| | - Harish M Tharayil
- Department of Psychiatry, Government Medical College, Kozhikode, Kerala, India
| | - Sagar Karia
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharastra, India
| | - Migita M D'Cruz
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sachin Nagendrappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Chittaranjan Andrade
- Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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22
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Rappel P, Marmor O, Bick AS, Arkadir D, Linetsky E, Castrioto A, Tamir I, Freedman SA, Mevorach T, Gilad M, Bergman H, Israel Z, Eitan R. Subthalamic theta activity: a novel human subcortical biomarker for obsessive compulsive disorder. Transl Psychiatry 2018; 8:118. [PMID: 29915200 PMCID: PMC6006433 DOI: 10.1038/s41398-018-0165-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/22/2018] [Indexed: 11/24/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a common and serious psychiatric disorder. Although subthalamic nucleus deep brain stimulation (DBS) has been studied as a treatment for OCD patients the underlying mechanism of this treatment and the optimal method of stimulation are unknown. To study the neural basis of subthalamic nucleus DBS in OCD patients we used a novel, implantable DBS system with long-term local field potential sensing capability. We focus our analysis on two patients with OCD who experienced severe treatment-resistant symptoms and were implanted with subthalamic nucleus DBS systems. We studied them for a year at rest and during provocation of OCD symptoms (46 recording sessions) and compared them to four Parkinson's disease (PD) patients implanted with subthalamic nucleus DBS systems (69 recording sessions). We show that the dorsal (motor) area of the subthalamic nucleus in OCD patients displays a beta (25-35 Hz) oscillatory activity similar to PD patients whereas the ventral (limbic-cognitive) area of the subthalamic nucleus displays distinct theta (6.5-8 Hz) oscillatory activity only in OCD patients. The subthalamic nucleus theta oscillatory activity decreases with provocation of OCD symptoms and is inversely correlated with symptoms severity over time. We conclude that beta oscillations at the dorsal subthalamic nucleus in OCD patients challenge their pathophysiologic association with movement disorders. Furthermore, theta oscillations at the ventral subthalamic nucleus in OCD patients suggest a new physiological target for OCD therapy as well as a promising input signal for future emotional-cognitive closed-loop DBS.
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Affiliation(s)
- Pnina Rappel
- 0000 0004 1937 0538grid.9619.7Department of Medical Neurobiology (Physiology), Institute of Medical Research – Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel ,0000 0004 1937 0538grid.9619.7The Edmond and Lily Safra Center for Brain Research, the Hebrew University, Jerusalem, Israel
| | - Odeya Marmor
- 0000 0004 1937 0538grid.9619.7Department of Medical Neurobiology (Physiology), Institute of Medical Research – Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel ,0000 0004 1937 0538grid.9619.7The Edmond and Lily Safra Center for Brain Research, the Hebrew University, Jerusalem, Israel
| | - Atira S Bick
- 0000 0004 1937 0538grid.9619.7Department of Medical Neurobiology (Physiology), Institute of Medical Research – Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel ,0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
| | - David Arkadir
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
| | - Eduard Linetsky
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
| | - Anna Castrioto
- 0000 0004 0429 3736grid.462307.4Grenoble Institute of Neuroscience, Grenoble, France
| | - Idit Tamir
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel ,0000 0001 2221 2926grid.17788.31The Center for Functional and Restorative Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel ,0000 0001 2297 6811grid.266102.1Department of Neurosurgery, University of California San Francisco, San Francisco, CA USA
| | - Sara A. Freedman
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel ,0000 0004 1937 0503grid.22098.31School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Tomer Mevorach
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
| | - Moran Gilad
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel
| | - Hagai Bergman
- 0000 0004 1937 0538grid.9619.7Department of Medical Neurobiology (Physiology), Institute of Medical Research – Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel ,0000 0004 1937 0538grid.9619.7The Edmond and Lily Safra Center for Brain Research, the Hebrew University, Jerusalem, Israel
| | - Zvi Israel
- 0000 0001 2221 2926grid.17788.31The Brain Division, Hadassah–Hebrew University Medical Center, Jerusalem, Israel ,0000 0001 2221 2926grid.17788.31The Center for Functional and Restorative Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Renana Eitan
- Department of Medical Neurobiology (Physiology), Institute of Medical Research - Israel-Canada, the Hebrew University-Hadassah Medical School, Jerusalem, Israel. .,The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. .,Department of Psychiatry, Functional Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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23
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Sharma M, Reeves K, Deogaonkar M, Rezai AR. Deep Brain Stimulation for Obsessive–Compulsive Disorder. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Adams WK, Vonder Haar C, Tremblay M, Cocker PJ, Silveira MM, Kaur S, Baunez C, Winstanley CA. Deep-Brain Stimulation of the Subthalamic Nucleus Selectively Decreases Risky Choice in Risk-Preferring Rats. eNeuro 2017; 4:ENEURO.0094-17.2017. [PMID: 28791332 PMCID: PMC5547195 DOI: 10.1523/eneuro.0094-17.2017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/15/2017] [Accepted: 07/03/2017] [Indexed: 11/21/2022] Open
Abstract
Deep brain stimulation of the subthalamic nucleus (STN-DBS) can improve the motor symptoms of Parkinson's disease (PD) and negate the problematic side effects of dopamine replacement therapy. Although there is concern that STN-DBS may enhance the development of gambling disorder and other impulse control disorders in this patient group, recent data suggest that STN-DBS may actually reduce iatrogenic impulse control disorders, and alleviate obsessive-compulsive disorder (OCD). Here, we sought to determine whether STN-DBS was beneficial or detrimental to performance of the rat gambling task (rGT), a rodent analogue of the Iowa Gambling Task (IGT) used to assess risky decision making clinically. Rats chose between four options associated with different amounts and probabilities of sugar pellet rewards versus timeout punishments. As in the IGT, the optimal approach was to favor options associated with smaller per-trial gains but lower timeout penalties. Once a stable behavioral baseline was established, electrodes were implanted bilaterally into the STN, and the effects of STN-DBS assessed on-task over 10 consecutive sessions using an A-B-A design. STN-DBS did not affect choice in optimal decision makers that correctly favored options associated with smaller per-trial gains but also lower penalties. However, a minority (∼25%) preferred the maladaptive "high-risk, high-reward" options at baseline. STN-DBS significantly and progressively improved choice in these risk-preferring rats. These data support the hypothesis that STN-DBS may be beneficial in ameliorating maladaptive decision making associated with compulsive and addiction disorders.
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Affiliation(s)
- Wendy K. Adams
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - Cole Vonder Haar
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - Melanie Tremblay
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - Paul J. Cocker
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - Mason M. Silveira
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - Sukhbir Kaur
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - Christelle Baunez
- Institut de Neurosciences de la Timone, UMR7289 Centre National de la Recherche Scientifique and Aix-Marseille Université, 13005, Marseille, France
| | - Catharine A. Winstanley
- Department of Psychology, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver V6T 1Z3, Canada
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Choreatic Side Effects of Deep Brain Stimulation of the Anteromedial Subthalamic Nucleus for Treatment-Resistant Obsessive-Compulsive disorder. World Neurosurg 2017; 104:1048.e9-1048.e13. [PMID: 28532905 DOI: 10.1016/j.wneu.2017.05.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with treatment-resistant obsessive-compulsive disorder (OCD) are potential candidates for deep brain stimulation (DBS). The anteromedial subthalamic nucleus (STN) is among the most commonly used targets for DBS in OCD. CASE DESCRIPTION We present a patient with a 30-year history of treatment-resistant OCD who underwent anteromedial STN-DBS. Despite a clear mood-enhancing effect, stimulation caused motor side effects, including bilateral hyperkinesia, dyskinesias, and sudden large amplitude choreatic movements of arms and legs when stimulating at voltages greater than approximately 1.5 V. DBS at lower amplitudes and at other contact points failed to result in a significant reduction of obsessions and compulsions without inducing motor side effects. Because of this limitation in programming options, we decided to reoperate and target the ventral capsule/ventral striatum (VC/VS), which resulted in a substantial reduction in key obsessive and compulsive symptoms without serious side effects. CONCLUSIONS Choreatic movements and hemiballismus have previously been linked to STN dysfunction and have been incidentally reported as side effects of DBS of the dorsolateral STN in Parkinson disease (PD). However, in PD, these side effects were usually transient, and they rarely interfered with DBS programming. In our patient, the motor side effects were persistent, and they made optimal DBS programming impossible. To our knowledge, such severe and persistent motor side effects have not been described previously for anteromedial STN-DBS.
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