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Muacevic A, Adler JR. Application of Deep Brain Stimulation in Refractory Post-Traumatic Stress Disorder. Cureus 2023; 15:e33780. [PMID: 36819333 PMCID: PMC9928537 DOI: 10.7759/cureus.33780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/14/2023] [Indexed: 01/16/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a mental disorder that produces crippling anxiety and occurs in response to an extreme, traumatic stressor. Compared to the prevalence of PTSD in the general population, the prevalence of PTSD in at-risk populations (e.g., army veterans, those affected by environmental calamities, and others) can reach up to threefold. The conventional treatment of PTSD involves using SSRIs (serotonin reuptake inhibitors) and other anti-depressants along with psychotherapy such as debriefing and CBT (cognitive behavioral therapy). Due to increasing resistance to conventional treatment, more novel treatment options, such as stellate ganglion block shots and neuromodulation, are being explored. These neuromodulation techniques include transcranial magnetic stimulation (TMS), transcranial direct current stimulation (TDS), and deep brain stimulation (DBS). The rationale behind employing these techniques in refractory PTSD is the altered neurocircuitry seen in PTSD patients, which can be visualized on imaging. Studies involving the use of DBS for PTSD primarily target specific areas in the brain: the amygdala, the prefrontal cortex, the hippocampus, and the hypothalamus. This article aims to provide a brief overview of the various neuromodulation techniques currently employed in the management of treatment-resistant PTSD and an in-depth review of the available literature on animal models in which DBS for PTSD has been researched. We also shed light on the human clinical trials conducted for the same.
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Qin C, Bian XL, Wu HY, Xian JY, Cai CY, Lin YH, Zhou Y, Kou XL, Chang L, Luo CX, Zhu DY. Dorsal Hippocampus to Infralimbic Cortex Circuit is Essential for the Recall of Extinction Memory. Cereb Cortex 2021; 31:1707-1718. [PMID: 33188393 DOI: 10.1093/cercor/bhaa320] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 12/30/2022] Open
Abstract
Posttraumatic stress disorder subjects usually show impaired recall of extinction memory, leading to extinguished fear relapses. However, little is known about the neural mechanisms underlying the impaired recall of extinction memory. We show here that the activity of dorsal hippocampus (dHPC) to infralimbic (IL) cortex circuit is essential for the recall of fear extinction memory in male mice. There were functional neural projections from the dHPC to IL. Using optogenetic manipulations, we observed that silencing the activity of dHPC-IL circuit inhibited recall of extinction memory while stimulating the activity of dHPC-IL circuit facilitated recall of extinction memory. "Impairment of extinction consolidation caused by" conditional deletion of extracellular signal-regulated kinase 2 (ERK2) in the IL prevented the dHPC-IL circuit-mediated recall of extinction memory. Moreover, silencing the dHPC-IL circuit abolished the effect of intra-IL microinjection of ERK enhancer on the recall of extinction memory. Together, we identify a dHPC to IL circuit that mediates the recall of extinction memory, and our data suggest that the dysfunction of dHPC-IL circuit and/or impaired extinction consolidation may contribute to extinguished fear relapses.
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Affiliation(s)
- Cheng Qin
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Xin-Lan Bian
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Hai-Yin Wu
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Jia-Yun Xian
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Cheng-Yun Cai
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Yu-Hui Lin
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Ying Zhou
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Xiao-Lin Kou
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Lei Chang
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
| | - Chun-Xia Luo
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
- Department of Pharmacology, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou 510000, China
| | - Dong-Ya Zhu
- Department of Pharmacology, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
- Institution of Stem Cells and Neuroregeneration, Nanjing Medical University, Nanjing 211166, China
- Department of Pharmacology, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou 510000, China
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Méndez-Couz M, Becker JM, Manahan-Vaughan D. Functional Compartmentalization of the Contribution of Hippocampal Subfields to Context-Dependent Extinction Learning. Front Behav Neurosci 2019; 13:256. [PMID: 31798429 PMCID: PMC6868086 DOI: 10.3389/fnbeh.2019.00256] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/28/2019] [Indexed: 12/15/2022] Open
Abstract
During extinction learning (EL), an individual learns that a previously learned behavior no longer fulfills its original purpose, or is no longer relevant. Recent studies have contradicted earlier theories that EL comprises forgetting, or the inhibition of the previously learned behavior, and indicate that EL comprises new associative learning. This suggests that the hippocampus is involved in this process. Empirical evidence is lacking however. Here, we used fluorescence in situ hybridization of somatic immediate early gene (IEG) expression to scrutinize if the hippocampus processes EL. Rodents engaged in context-dependent EL and were also tested for renewal of (the original behavioral response to) a spatial appetitive task in a T-maze. Whereas distal and proximal CA1 subfields processed both EL and renewal, effects in the proximal CA1 were more robust consistent with a role of this subfield in processing context. The lower blade of the dentate gyrus (DG) and the proximal CA3 subfields were particularly involved in renewal. Responses in the distal and proximal CA3 subfields suggest that this hippocampal subregion may also contribute to the evaluation of the reward outcome. Taken together, our findings provide novel and direct evidence for the involvement of distinct hippocampal subfields in context-dependent EL and renewal.
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Affiliation(s)
- Marta Méndez-Couz
- Department of Neurophysiology, Medical Faculty, Ruhr University Bochum, Bochum, Germany
| | - Jana M Becker
- Department of Neurophysiology, Medical Faculty, Ruhr University Bochum, Bochum, Germany
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Gouveia FV, Gidyk DC, Giacobbe P, Ng E, Meng Y, Davidson B, Abrahao A, Lipsman N, Hamani C. Neuromodulation Strategies in Post-Traumatic Stress Disorder: From Preclinical Models to Clinical Applications. Brain Sci 2019; 9:brainsci9020045. [PMID: 30791469 PMCID: PMC6406551 DOI: 10.3390/brainsci9020045] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/02/2019] [Accepted: 02/15/2019] [Indexed: 12/18/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is an often debilitating disease with a lifetime prevalence rate between 5⁻8%. In war veterans, these numbers are even higher, reaching approximately 10% to 25%. Although most patients benefit from the use of medications and psychotherapy, approximately 20% to 30% do not have an adequate response to conventional treatments. Neuromodulation strategies have been investigated for various psychiatric disorders with promising results, and may represent an important treatment option for individuals with difficult-to-treat forms of PTSD. We review the relevant neurocircuitry and preclinical stimulation studies in models of fear and anxiety, as well as clinical data on the use of transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and deep brain stimulation (DBS) for the treatment of PTSD.
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Affiliation(s)
| | - Darryl C Gidyk
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada.
| | - Peter Giacobbe
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada.
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Enoch Ng
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Ying Meng
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Benjamin Davidson
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Agessandro Abrahao
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
| | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada.
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
| | - Clement Hamani
- Sunnybrook Research Institute, Toronto, ON M4N3M5, Canada.
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
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Abstract
During extinction, the organism learns that a conditioned stimulus or a conditioned response is no longer associated with an unconditioned stimulus, and as a consequence, a decrement in the response is presented. The exposure to novel situations (e.g. exploration of a novel open field) has been used widely to modulate (i.e. either enhance or deteriorate) learning and memory. The aim of the present study was to test whether open-field exposure could modulate consummatory extinction. The results indicated that open-field exposure accelerated the extinction response (i.e. experimental animals provided novelty exposure had lower consummatory behavior than control animals) when applied before - but not after - the first extinction trial, or when applied before the second extinction trial. The results suggest that environmental treatments such as novelty exposure provide a valuable, nonpharmacological alternative to potentially modulate extinction processes.
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Reznikov R, Binko M, Nobrega JN, Hamani C. Deep Brain Stimulation in Animal Models of Fear, Anxiety, and Posttraumatic Stress Disorder. Neuropsychopharmacology 2016; 41:2810-2817. [PMID: 26932819 PMCID: PMC5061888 DOI: 10.1038/npp.2016.34] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/11/2016] [Accepted: 01/27/2016] [Indexed: 01/17/2023]
Abstract
Although medications and psychotherapy are often effective for the treatment of posttraumatic stress disorder (PTSD), 20-30% of patients do not respond to these conventional therapies. In psychiatry, DBS has been either approved or is currently under investigation for different disorders. At present, whether DBS may be used to treat PTSD remains unknown. Preclinical research may provide the scientific rationale for helping conceive and further improve such trials. Some of the animal models commonly used to date are more suitable for investigating mechanisms of anxiety and fear than the long-lasting behavior that characterized PTSD. That said, mechanisms and neurocircuits involved in paradigms such as fear conditioning and extinction share several common features with those of PTSD. In this article, we review preclinical studies in which electrical stimulation has been delivered to animal models of PTSD-like behavior. In those studies, commonly targeted regions were the basolateral amygdala, ventral striatum, hippocampus, and prefrontal cortex. Overall, stimulation delivered at high frequencies to most of these targets improved fear extinction and anxiety-like behavior. Though further research is certainly needed, promising findings from DBS studies in animals are encouraging and suggest a positive future perspective for the field.
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Affiliation(s)
- Roman Reznikov
- Behavioural Neurobiology Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mary Binko
- Behavioural Neurobiology Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - José N Nobrega
- Behavioural Neurobiology Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada,Departments of Psychiatry, Pharmacology and Toxicology, and Psychology, University of Toronto, Toronto, ON, Canada
| | - Clement Hamani
- Behavioural Neurobiology Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada,Division of Neurosurgery, Toronto Western Hospital, Toronto, ON, Canada,Neuroimaging Research Section, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON M5T 1R8, Canada, Tel: +1 416 5358501, ext 4295, Fax: +1 416 6035298, E-mail:
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Le Dorze C, Gisquet-Verrier P. Effects of multiple brief exposures to trauma-associated cues on traumatized resilient and vulnerable rats. Brain Res 2016; 1652:71-80. [PMID: 27717871 DOI: 10.1016/j.brainres.2016.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/26/2016] [Accepted: 10/03/2016] [Indexed: 11/16/2022]
Abstract
Intrusive re-experiencing of a trauma is a core symptom in post-traumatic stress disorder (PTSD), and is often triggered by contextual cues associated with the event. It is not yet established if intrusive re-experiencing is the consequence of PTSD, or if it could contribute to the development of PTSD following a traumatic event. The present study (1) examined the impact of repeated brief re-exposures to trauma reminders on the strength of PTSD-like symptoms, as well as on their time-development and (2) investigated the reactivity over time to these cues in trauma resilient and vulnerable rats, defined on the basis of the PTSD-like symptoms they demonstrated. Rats were exposed to a Single Prolonged Stress, combining three different stresses (2-h restraint, 20-min forced swim and CO2 unconsciousness) delivered together with tone and odor cues and preceded by an inhibitory avoidance conditioning or a control procedure. During the following two weeks, reminded rats were briefly re-exposed to trauma-associated cues either 4 or 8 times. The results indicated that 4 re-exposures to the same cue strengthened PTSD-like symptoms (anxiety, arousal, fear to trauma-cue). However 8 re-exposures to similar or different trauma-cues did not alter PTSD-like symptoms and led to a rapid extinction of the fear reactivity to these cues. The present results further indicated that shortly after trauma, both resilient and vulnerable rats strongly reacted to trauma-associated cues, while only vulnerable rats reacted long after the trauma, suggesting a slower loss of fear responses to trauma cues in these rats. We concluded that re-experiencing may participate in, but cannot be solely responsible for, the development of long-term PTSD effects.
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Affiliation(s)
- Claire Le Dorze
- Neuro-PSI, Université Paris-Sud, CNRS UMR9197, Université Paris-Saclay, Orsay, France
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8
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Méndez-Couz M, González-Pardo H, Vallejo G, Arias JL, Conejo NM. Spatial memory extinction differentially affects dorsal and ventral hippocampal metabolic activity and associated functional brain networks. Hippocampus 2016; 26:1265-75. [DOI: 10.1002/hipo.22602] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/22/2016] [Accepted: 04/08/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Marta Méndez-Couz
- Laboratory of Neuroscience; Department of Psychology; Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo; Plaza Feijoo Oviedo Spain
| | - Héctor González-Pardo
- Laboratory of Neuroscience; Department of Psychology; Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo; Plaza Feijoo Oviedo Spain
| | - Guillermo Vallejo
- Methodology Area; Department of Psychology; Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo; Plaza Feijoo Oviedo Spain
| | - Jorge L. Arias
- Laboratory of Neuroscience; Department of Psychology; Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo; Plaza Feijoo Oviedo Spain
| | - Nélida M. Conejo
- Laboratory of Neuroscience; Department of Psychology; Instituto de Neurociencias del Principado de Asturias (INEUROPA), University of Oviedo; Plaza Feijoo Oviedo Spain
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9
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Méndez-Couz M, Conejo NM, Vallejo G, Arias JL. Brain functional network changes following Prelimbic area inactivation in a spatial memory extinction task. Behav Brain Res 2015; 287:247-55. [DOI: 10.1016/j.bbr.2015.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/11/2015] [Accepted: 03/16/2015] [Indexed: 02/07/2023]
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10
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Gill KM, Grace AA. Differential effects of acute and repeated stress on hippocampus and amygdala inputs to the nucleus accumbens shell. Int J Neuropsychopharmacol 2013; 16:2013-25. [PMID: 23745764 PMCID: PMC3758801 DOI: 10.1017/s1461145713000618] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The basolateral amygdala (BLA) and ventral subiculum (vSub) of the hippocampus convey emotion and context information, respectively, to the nucleus accumbens (NAc). Using in vivo extracellular recordings from NAc neurons, we examined how acute and repeated restraint stress alters the plasticity of the vSub and BLA afferent pathways. High-frequency (HFS) and low-frequency (LFS) stimulation was applied to the vSub to assess the impact on NAc responses to vSub and BLA inputs. In addition, iontophoretic application of the dopamine D2-antagonist sulpiride was used to explore the role of dopamine in the NAc in mediating the effects of stress on plasticity. Acute and repeated restraint caused disparate effects on BLA- and vSub-evoked responses in the NAc. Following repeated restraint, but not after acute restraint, HFS of the vSub failed to potentiate the vSub–NAc pathway while instead promoting a long-lasting reduction of the BLA–NAc pathway and these effects were independent of D2-receptor activity. In contrast, LFS to the vSub pathway after acute restraint resulted in potentiation in the vSub–NAc pathway while BLA-evoked responses were unchanged. When sulpiride was applied prior to LFS of the vSub after acute stress, there was a pronounced decrease in vSub-evoked responses similar to control animals. This work provides new insight into the impact of acute and repeated stress on the integration of context and emotion inputs in the NAc. These data support a model of stress whereby the hippocampus is inappropriately activated and dominates the information processing within this circuit via a dopaminergic mechanism after acute bouts of stress.
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Affiliation(s)
- Kathryn M Gill
- Departments of Neuroscience, Psychiatry and Psychology, University of Pittsburgh, PA 15260, USA.
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11
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Donner NC, Lowry CA. Sex differences in anxiety and emotional behavior. Pflugers Arch 2013; 465:601-26. [PMID: 23588380 DOI: 10.1007/s00424-013-1271-7] [Citation(s) in RCA: 227] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/13/2013] [Accepted: 03/13/2013] [Indexed: 12/14/2022]
Abstract
Research has elucidated causal links between stress exposure and the development of anxiety disorders, but due to the limited use of female or sex-comparative animal models, little is known about the mechanisms underlying sex differences in those disorders. This is despite an overwhelming wealth of evidence from the clinical literature that the prevalence of anxiety disorders is about twice as high in women compared to men, in addition to gender differences in severity and treatment efficacy. We here review human gender differences in generalized anxiety disorder, panic disorder, posttraumatic stress disorder and anxiety-relevant biological functions, discuss the limitations of classic conflict anxiety tests to measure naturally occurring sex differences in anxiety-like behaviors, describe sex-dependent manifestation of anxiety states after gestational, neonatal, or adolescent stressors, and present animal models of chronic anxiety states induced by acute or chronic stressors during adulthood. Potential mechanisms underlying sex differences in stress-related anxiety states include emerging evidence supporting the existence of two anatomically and functionally distinct serotonergic circuits that are related to the modulation of conflict anxiety and panic-like anxiety, respectively. We discuss how these serotonergic circuits may be controlled by reproductive steroid hormone-dependent modulation of crfr1 and crfr2 expression in the midbrain dorsal raphe nucleus and by estrous stage-dependent alterations of γ-aminobutyric acid (GABAergic) neurotransmission in the periaqueductal gray, ultimately leading to sex differences in emotional behavior.
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Affiliation(s)
- Nina C Donner
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, 1725 Pleasant Street, 114 Clare Small, Boulder, CO 80309-0354, USA.
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