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Jang M, Kim M, Park S, Myung HS, Paek SH, Kwon JS. Characteristics of Patients With Intractable Obsessive-Compulsive Disorder With High/Low Responsiveness to Gamma Knife Surgery. Psychiatry Investig 2024; 21:629-636. [PMID: 38960440 PMCID: PMC11222075 DOI: 10.30773/pi.2024.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is a psychiatric condition that causes significant distress and social costs and often follows a chronic course with frequent relapses. Approximately 20% of patients do not respond to medication or cognitive behavioral therapy; gamma knife surgery (GKS) has been proposed as a treatment option for these patients. However, research on GKS for OCD patients is rare. METHODS In this study, 10 patients with treatment-resistant OCD underwent GKS, and the treatment response and side effects were assessed. The improvement in patients' obsessive-compulsive symptoms was evaluated using the Yale-Brown Obsessive Compulsive Scale (YBOCS) scores following GKS. Additionally, the characteristics distinguishing the groups with favorable responses to GKS from those with less favorable responses were examined. RESULTS GKS was well tolerated, and patients demonstrated a statistically significant reduction in YBOCS scores before and after GKS (p=0.016). Patients that responded to GKS exhibited distinct characteristics from those who did not respond. Patients who responded poorly tended to present an earlier age of onset, a longer duration of illness, more frequent hospitalizations, poorer social functioning, and a greater incidence of suicide attempts/thoughts. CONCLUSION This study not only demonstrated that GKS is a safe and effective treatment method for intractable OCD but also revealed characteristics distinguishing patients who respond well to GKS from those who do not. These results may aid in the selection of patients for future application of GKS.
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Affiliation(s)
- Moonyoung Jang
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sunghyun Park
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ho Sung Myung
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
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Woods JE, Singer AL, Alrashdan F, Tan W, Tan C, Sheth SA, Sheth SA, Robinson JT. Miniature battery-free epidural cortical stimulators. SCIENCE ADVANCES 2024; 10:eadn0858. [PMID: 38608028 PMCID: PMC11014439 DOI: 10.1126/sciadv.adn0858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/11/2024] [Indexed: 04/14/2024]
Abstract
Miniaturized neuromodulation systems could improve the safety and reduce the invasiveness of bioelectronic neuromodulation. However, as implantable bioelectronic devices are made smaller, it becomes difficult to store enough power for long-term operation in batteries. Here, we present a battery-free epidural cortical stimulator that is only 9 millimeters in width yet can safely receive enough wireless power using magnetoelectric antennas to deliver 14.5-volt stimulation bursts, which enables it to stimulate cortical activity on-demand through the dura. The device has digitally programmable stimulation output and centimeter-scale alignment tolerances when powered by an external transmitter. We demonstrate that this device has enough power and reliability for real-world operation by showing acute motor cortex activation in human patients and reliable chronic motor cortex activation for 30 days in a porcine model. This platform opens the possibility of simple surgical procedures for precise neuromodulation.
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Affiliation(s)
- Joshua E. Woods
- Department of Electrical and Computer Engineering, Rice University, 6100 Main St, Houston, TX 77005, USA
| | - Amanda L. Singer
- Motif Neurotech, 2450 Holcombe Blvd, Houston, TX 77021, USA
- Applied Physics Program, Rice University, 6100 Main St, Houston, TX 77005, USA
| | - Fatima Alrashdan
- Department of Electrical and Computer Engineering, Rice University, 6100 Main St, Houston, TX 77005, USA
| | - Wendy Tan
- Department of Electrical and Computer Engineering, Rice University, 6100 Main St, Houston, TX 77005, USA
| | - Chunfeng Tan
- Department of Neurology, UTHealth McGovern Medical School, 6431 Fannin St, Houston, TX 77030, USA
| | - Sunil A. Sheth
- Department of Neurology, UTHealth McGovern Medical School, 6431 Fannin St, Houston, TX 77030, USA
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Jacob T. Robinson
- Department of Electrical and Computer Engineering, Rice University, 6100 Main St, Houston, TX 77005, USA
- Motif Neurotech, 2450 Holcombe Blvd, Houston, TX 77021, USA
- Applied Physics Program, Rice University, 6100 Main St, Houston, TX 77005, USA
- Department of Bioengineering, Rice University, 6100 Main St, Houston, TX 77005, USA
- Department of Neuroscience, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
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Chang JG, Kim SJ, Kim CH. Neuroablative Intervention for Refractory Obsessive-Compulsive Disorder. Psychiatry Investig 2023; 20:997-1006. [PMID: 37997327 PMCID: PMC10678146 DOI: 10.30773/pi.2023.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/19/2023] [Accepted: 08/29/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE This review aims to investigate the progression of neuroablation, along with documented clinical efficacy and safety, in the management of treatment-resistant obsessive-compulsive disorder (OCD). METHODS We searched and compiled clinical research results of neuroablation therapy reported to date. We extracted outcomes related to clinical efficacy, side effects, and surgical complications. Additionally, we summarized key claims and findings. RESULTS Neuroablative intervention is a potential treatment approach for refractory OCD. Recent advancements, such as real-time magnetic resonance monitoring and minimally invasive techniques employing ultrasound and laser, offer distinct advantages in terms of safety and comparative efficacy when compared to conventional methods. However, the absence of randomized controlled trials and long-term outcome data underscores the need for cautious consideration when selecting neuroablation. CONCLUSION Neuroablative intervention shows promise for refractory OCD, but vigilant consideration is essential in both patient selection and surgical method choices due to the potential for rare yet serious complications.
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Affiliation(s)
- Jhin Goo Chang
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Se Joo Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan-Hyung Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Hariz M, Cif L, Blomstedt P. Thirty Years of Global Deep Brain Stimulation: "Plus ça change, plus c'est la même chose"? Stereotact Funct Neurosurg 2023; 101:395-406. [PMID: 37844558 DOI: 10.1159/000533430] [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: 04/09/2023] [Accepted: 07/31/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND The advent of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease 30 years ago has ushered a global breakthrough of DBS as a universal method for therapy and research in wide areas of neurology and psychiatry. The literature of the last three decades has described numerous concepts and practices of DBS, often branded as novelties or discoveries. However, reading the contemporary publications often elicits a sense of déjà vu in relation to several methods, attributes, and practices of DBS. Here, we review various applications and techniques of the modern-era DBS and compare them with practices of the past. SUMMARY Compared with modern literature, publications of the old-era functional stereotactic neurosurgery, including old-era DBS, show that from the very beginning multidisciplinarity and teamwork were often prevalent and insisted upon, ethical concerns were recognized, brain circuitries and rational for brain targets were discussed, surgical indications were similar, closed-loop stimulation was attempted, evaluations of surgical results were debated, and controversies were common. Thus, it appears that virtually everything done today in the field of DBS bears resemblance to old-time practices, or has been done before, albeit with partly other tools and techniques. Movement disorders remain the main indications for modern DBS as was the case for lesional surgery and old-era DBS. The novelties today consist of the STN as the dominant target for DBS, the tremendous advances in computerized brain imaging, the sophistication and versatility of implantable DBS hardware, and the large potential for research. KEY MESSAGES Many aspects of contemporary DBS bear strong resemblance to practices of the past. The dominant clinical indications remain movement disorders with virtually the same brain targets as in the past, with one exception: the STN. Other novel brain targets - that are so far subject to DBS trials - are the pedunculopontine nucleus for gait freezing, the anteromedial internal pallidum for Gilles de la Tourette and the fornix for Alzheimer's disease. The major innovations and novelties compared to the past concern mainly the unmatched level of research activity, its high degree of sponsorship, and the outstanding advances in technology that have enabled multimodal brain imaging and the miniaturization, versatility, and sophistication of implantable hardware. The greatest benefit for patients today, compared to the past, is the higher level of precision and safety of DBS, and of all functional stereotactic neurosurgery.
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Affiliation(s)
- Marwan Hariz
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
- UCL Institute of Neurology, Queen Square, London, UK
| | - Laura Cif
- Laboratoire de Recherche en Neurosciences Cliniques, Montpellier, France
| | - Patric Blomstedt
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
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Perkes IE, Morris RW, Griffiths KR, Quail S, Waters F, O’Brien M, Hazell PL, Balleine BW. The Motivational Determinants of Human Action, Their Neural Bases and Functional Impact in Adolescents With Obsessive-Compulsive Disorder. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:1062-1072. [PMID: 37881550 PMCID: PMC10593889 DOI: 10.1016/j.bpsgos.2022.11.004] [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: 04/21/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Background Establishing the motivational influences on human action is essential for understanding choice and decision making in health and disease. Here we used tests of value-based decision making, manipulating both predicted and experienced reward values to assess the motivational control of goal-directed action in healthy adolescents and those with obsessive-compulsive disorder (OCD). Methods After instrumental training on a two action-two outcome probabilistic task, adolescents (n = 21) underwent Pavlovian conditioning using distinct stimuli predicting either the instrumental outcomes, a third outcome, or nothing. We then assessed functional magnetic resonance imaging during choice tests in which we varied the predicted value, using specific and general Pavlovian-instrumental transfer, and the experienced value, using outcome devaluation. To establish functional significance, we tested a matched cohort of adolescents with OCD (n = 20). Results In healthy adolescents, both predicted and experienced values influenced the performance of goal-directed actions, mediated by distinct orbitofrontal-striatal circuits involving the lateral orbitofrontal cortex (OFC) and medial OFC, respectively. However, in adolescents with OCD, choice was insensitive to changes in either predicted or experienced values. These impairments were related to hypoactivity in the lateral OFC and hyperactivity in the medial OFC during specific Pavlovian-instrumental transfer and hypoactivity in the anterior prefrontal cortex, caudate nucleus, and their connectivity in the devaluation test. Conclusions We found that predicted and experienced values exerted a potent influence on the performance of goal-directed actions in adolescents via distinct orbitofrontal- and prefrontal-striatal circuits. Furthermore, the influence of these motivational processes was severely blunted in OCD, as was the functional segregation of circuits involving medial and lateral OFC, producing dysregulated action control.
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Affiliation(s)
- Iain E. Perkes
- Decision Neuroscience Laboratory, University of New South Wales (UNSW) Sydney, Sydney, New South Wales, Australia
- Discipline of Psychiatry and Mental Health and Discipline of Paediatrics and Children’s Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Department of Psychological Medicine, Sydney Children’s Hospital Network, Sydney, New South Wales, Australia
| | - Richard W. Morris
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Kristi R. Griffiths
- Brain Dynamics Centre, The Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
| | - Stephanie Quail
- Decision Neuroscience Laboratory, University of New South Wales (UNSW) Sydney, Sydney, New South Wales, Australia
| | - Felicity Waters
- Child and Adolescent Mental Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Margot O’Brien
- Child and Adolescent Mental Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Philip L. Hazell
- Child and Adolescent Mental Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
- Specialty of Psychiatry, The University of Sydney, Sydney, New South Wales, Australia
| | - Bernard W. Balleine
- Decision Neuroscience Laboratory, University of New South Wales (UNSW) Sydney, Sydney, New South Wales, Australia
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Kostick-Quenet K, Kalwani L, Torgerson L, Muñoz K, Sanchez C, Storch EA, Blumenthal-Barby J, Lázaro-Muñoz G. Deep Brain Stimulation for Pediatric Dystonia: Clinicians' Perspectives on the Most Pressing Ethical Challenges. Stereotact Funct Neurosurg 2023; 101:301-313. [PMID: 37844562 PMCID: PMC10586720 DOI: 10.1159/000530694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/30/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Pediatric deep brain stimulation (pDBS) is commonly used to manage treatment-resistant primary dystonias with favorable results and more frequently used for secondary dystonia to improve quality of life. There has been little systematic empirical neuroethics research to identify ethical challenges and potential solutions to ensure responsible use of DBS in pediatric populations. METHODS Clinicians (n = 29) who care for minors with treatment-resistant dystonia were interviewed for their perspectives on the most pressing ethical issues in pDBS. RESULTS Using thematic content analysis to explore salient themes, clinicians identified four pressing concerns: (1) uncertainty about risks and benefits of pDBS (22/29; 72%) that poses a challenge to informed decision-making; (2) ethically navigating decision-making roles (15/29; 52%), including how best to integrate perspectives from diverse stakeholders (patient, caregiver, clinician) and how to manage surrogate decisions on behalf of pediatric patients with limited capacity to make autonomous decisions; (3) information scarcity effects on informed consent and decision quality (15/29; 52%) in the context of patient and caregivers' expectations for treatment; and (4) narrow regulatory status and access (7/29; 24%) such as the lack of FDA-approved indications that contribute to decision-making uncertainty and liability and potentially limit access to DBS among patients who may benefit from it. CONCLUSION These results suggest that clinicians are primarily concerned about ethical limitations of making difficult decisions in the absence of informational, regulatory, and financial supports. We discuss two solutions already underway, including supported decision-making to address uncertainty and further data sharing to enhance clinical knowledge and discovery.
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Affiliation(s)
- Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Lavina Kalwani
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Katrina Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Clarissa Sanchez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard Medical School, Cambridge, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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Lv Q, Zeljic K, Zhao S, Zhang J, Zhang J, Wang Z. Dissecting Psychiatric Heterogeneity and Comorbidity with Core Region-Based Machine Learning. Neurosci Bull 2023; 39:1309-1326. [PMID: 37093448 PMCID: PMC10387015 DOI: 10.1007/s12264-023-01057-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/17/2023] [Indexed: 04/25/2023] Open
Abstract
Machine learning approaches are increasingly being applied to neuroimaging data from patients with psychiatric disorders to extract brain-based features for diagnosis and prognosis. The goal of this review is to discuss recent practices for evaluating machine learning applications to obsessive-compulsive and related disorders and to advance a novel strategy of building machine learning models based on a set of core brain regions for better performance, interpretability, and generalizability. Specifically, we argue that a core set of co-altered brain regions (namely 'core regions') comprising areas central to the underlying psychopathology enables the efficient construction of a predictive model to identify distinct symptom dimensions/clusters in individual patients. Hypothesis-driven and data-driven approaches are further introduced showing how core regions are identified from the entire brain. We demonstrate a broadly applicable roadmap for leveraging this core set-based strategy to accelerate the pursuit of neuroimaging-based markers for diagnosis and prognosis in a variety of psychiatric disorders.
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Affiliation(s)
- Qian Lv
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, IDG/McGovern Institute for Brain Research, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, 100871, China.
| | - Kristina Zeljic
- School of Health and Psychological Sciences, City, University of London, London, EC1V 0HB, UK
| | - Shaoling Zhao
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, 200031, China
- University of Chinese Academy of Sciences, Beijing, 101408, China
| | - Jiangtao Zhang
- Tongde Hospital of Zhejiang Province (Zhejiang Mental Health Center), Zhejiang Office of Mental Health, Hangzhou, 310012, China
| | - Jianmin Zhang
- Tongde Hospital of Zhejiang Province (Zhejiang Mental Health Center), Zhejiang Office of Mental Health, Hangzhou, 310012, China
| | - Zheng Wang
- School of Psychological and Cognitive Sciences, Beijing Key Laboratory of Behavior and Mental Health, IDG/McGovern Institute for Brain Research, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, 100871, China.
- School of Biomedical Engineering, Hainan University, Haikou, 570228, China.
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Shofty B, Gadot R, Viswanathan A, Provenza NR, Storch EA, McKay SA, Meyers MS, Hertz AG, Avendano-Ortega M, Goodman WK, Sheth SA. Intraoperative valence testing to adjudicate between ventral capsule/ventral striatum and bed nucleus of the stria terminalis target selection in deep brain stimulation for obsessive-compulsive disorder. J Neurosurg 2023; 139:442-450. [PMID: 36681982 DOI: 10.3171/2022.10.jns221683] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an accepted therapy for severe, treatment-refractory obsessive-compulsive disorder (trOCD). The optimal DBS target location within the anterior limb of the internal capsule, particularly along the anterior-posterior axis, remains elusive. Empirical evidence from several studies in the past decade has suggested that the ideal target lies in the vicinity of the anterior commissure (AC), either just anterior to the AC, above the ventral striatum (VS), or just posterior to the AC, above the bed nucleus of the stria terminalis (BNST). Various methods have been utilized to optimize target selection for trOCD DBS. The authors describe their practice of planning trajectories to both the VS and BNST and adjudicating between them with awake intraoperative valence testing to individualize permanent target selection. METHODS Eight patients with trOCD underwent awake DBS with trajectories planned for both VS and BNST targets bilaterally. The authors intraoperatively assessed the acute effects of stimulation on mood, energy, and anxiety and implanted the trajectory with the most reliable positive valence responses and least stimulation-induced side effects. The method of intraoperative target adjudication is described, and the OCD outcome at last follow-up is reported. RESULTS The mean patient age at surgery was 41.25 ± 15.1 years, and the mean disease duration was 22.75 ± 10.2 years. The median preoperative Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 39 (range 34-40). Two patients had previously undergone capsulotomy, with insufficient response. Seven (44%) of 16 leads were moved to the second target based on intraoperative stimulation findings, 4 of them to avoid strong negative valence effects. Three patients had an asymmetric implant (1 lead in each target). All 8 patients (100%) met full response criteria, and the mean Y-BOCS score reduction across the full cohort was 51.2% ± 12.8%. CONCLUSIONS Planning and intraoperatively testing trajectories flanking the AC-superjacent to the VS anteriorly and to the BNST posteriorly-allowed identification of positive valence responses and acute adverse effects. Awake testing helped to select between possible trajectories and identify individually optimized targets in DBS for trOCD.
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Affiliation(s)
- Ben Shofty
- 1Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and
| | | | | | | | - Eric A Storch
- 3Psychiatry, Baylor College of Medicine, Houston, Texas
| | - Sarah A McKay
- 3Psychiatry, Baylor College of Medicine, Houston, Texas
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Laseca-Zaballa G, Lubrini G, Periañez JA, Simón-Martínez V, Martín Bejarano M, Torres-Díaz C, Martínez Moreno N, Álvarez-Linera J, Martínez Álvarez R, Ríos-Lago M. Cognitive outcomes following functional neurosurgery in refractory OCD patients: a systematic review. Neurosurg Rev 2023; 46:145. [PMID: 37351641 PMCID: PMC10289910 DOI: 10.1007/s10143-023-02037-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 04/26/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023]
Abstract
Neurosurgery is a therapeutic option for patients with refractory obsessive-compulsive disorder who do not respond to previous treatments. Although its efficacy in reducing clinical symptomatology has been proven, few studies have analyzed its effects at the cognitive level. The aim of this systematic review was to describe the cognitive outcomes of functional neurosurgery in patients that went through capsulotomies or cingulotomies. PubMed, Medline, Scopus, PsycInfo, PsyArticles, and Web of Knowledge were searched for studies reporting cognitive outcomes in refractory obsessive-compulsive patients after capsulotomies and cingulotomies. The risk of bias was assessed with the Assessment Tool for Before-After (Pre-Post) Studies With No Control Group tool; 13 studies met inclusion criteria, including 205 refractory obsessive-compulsive disorder patients for both surgical procedures. Results showed a substantial number of studies that did report significant cognitive improvement after surgery, being this improvement specially related to memory and executive functions. The second-most frequent finding is the maintenance of cognitive performance (nor improvement or worsening). From a neuropsychological point of view, this outcome might be considered a success, given that it is accompanied by amelioration of obsessive-compulsive symptoms. Subtle cognitive adverse effects have also been reported. Neurosurgery procedures appear to be safe from a cognitive point of view. Methodological issues must be improved to draw clearer conclusions, but capsulotomies and cingulotomies constitute an effective alternative treatment for refractory obsessive-compulsive disorder patients.
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Affiliation(s)
- G Laseca-Zaballa
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Complutense University of Madrid, Madrid, Spain
| | - G Lubrini
- Department of Basic Psychology II, UNED, Madrid, Spain
| | - J A Periañez
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Complutense University of Madrid, Madrid, Spain
| | | | - M Martín Bejarano
- Neuropsychology Service, Fidias Health & Sport, Cádiz, Spain
- Faculty of Medicine, University of Cádiz, Cádiz, Spain
| | - C Torres-Díaz
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - N Martínez Moreno
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - J Álvarez-Linera
- Department of Radiodiagnosis, Ruber International Hospital, Madrid, Spain
| | - R Martínez Álvarez
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - M Ríos-Lago
- Department of Basic Psychology II, UNED, Madrid, Spain.
- Brain Damage Service, Beata Maria Ana Hospital, Madrid, Spain.
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10
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McLaughlin NCR, Magnotti JF, Banks GP, Nanda P, Hoexter MQ, Lopes AC, Batistuzzo MC, Asaad WF, Stewart C, Paulo D, Noren G, Greenberg BD, Malloy P, Salloway S, Correia S, Pathak Y, Sheehan J, Marsland R, Gorgulho A, De Salles A, Miguel EC, Rasmussen SA, Sheth SA. Gamma knife capsulotomy for intractable OCD: Neuroimage analysis of lesion size, location, and clinical response. Transl Psychiatry 2023; 13:134. [PMID: 37185805 PMCID: PMC10130137 DOI: 10.1038/s41398-023-02425-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 02/27/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) affects 2-3% of the population. One-third of patients are poorly responsive to conventional therapies, and for a subgroup, gamma knife capsulotomy (GKC) is an option. We examined lesion characteristics in patients previously treated with GKC through well-established programs in Providence, RI (Butler Hospital/Rhode Island Hospital/Alpert Medical School of Brown University) and São Paulo, Brazil (University of São Paolo). Lesions were traced on T1 images from 26 patients who had received GKC targeting the ventral half of the anterior limb of the internal capsule (ALIC), and the masks were transformed into MNI space. Voxel-wise lesion-symptom mapping was performed to assess the influence of lesion location on Y-BOCS ratings. General linear models were built to compare the relationship between lesion size/location along different axes of the ALIC and above or below-average change in Y-BOCS ratings. Sixty-nine percent of this sample were full responders (≥35% improvement in OCD). Lesion occurrence anywhere within the targeted region was associated with clinical improvement, but modeling results demonstrated that lesions occurring posteriorly (closer to the anterior commissure) and dorsally (closer to the mid-ALIC) were associated with the greatest Y-BOCS reduction. No association was found between Y-BOCS reduction and overall lesion volume. GKC remains an effective treatment for refractory OCD. Our data suggest that continuing to target the bottom half of the ALIC in the coronal plane is likely to provide the dorsal-ventral height required to achieve optimal outcomes, as it will cover the white matter pathways relevant to change. Further analysis of individual variability will be essential for improving targeting and clinical outcomes, and potentially further reducing the lesion size necessary for beneficial outcomes.
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Affiliation(s)
- N C R McLaughlin
- Butler Hospital, Providence, RI, USA.
- Alpert Medical School of Brown University, Providence, RI, USA.
| | - J F Magnotti
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - G P Banks
- Columbia University Medical Center, New York, NY, USA
| | - P Nanda
- Columbia University Medical Center, New York, NY, USA
| | - M Q Hoexter
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - A C Lopes
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - M C Batistuzzo
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Department of Methods and Techniques in Psychology, Pontifical Catholic University, São Paulo, SP, Brazil
| | - W F Asaad
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - C Stewart
- Boston University School of Public Health, Boston, MA, USA
| | - D Paulo
- Columbia University Medical Center, New York, NY, USA
| | - G Noren
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - B D Greenberg
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
- Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - P Malloy
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | - S Salloway
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
| | - S Correia
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Y Pathak
- Columbia University Medical Center, New York, NY, USA
| | - J Sheehan
- University of Virginia, Charlottesville, VA, USA
| | | | - A Gorgulho
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - A De Salles
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - E C Miguel
- Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - S A Rasmussen
- Butler Hospital, Providence, RI, USA
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | - S A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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11
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Chang JG, Kim DW, Jung HH, Chang WS, Kim CH, Kim SJ, Chang JW. Evaluation of changes in neural oscillation after bilateral capsulotomy in treatment refractory obsessive-compulsive disorder using magnetoencephalogram. Asian J Psychiatr 2023; 82:103473. [PMID: 36706511 DOI: 10.1016/j.ajp.2023.103473] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
Bilateral thermal capsulotomy with magnetic resonance-guided focused ultrasound (MRgFUS-capsulotomy) is a promising treatment option for treatment-refractory obsessive-compulsive disorder (OCD). Herein, we investigated the effects of bilateral thermal capsulotomy with MRgFUS on neural oscillations in treatment-refractory OCD patients. Eight patients underwent resting-state MEG with repeated recordings before and 1 and 6 months after MRgFUS-capsulotomy, and the oscillatory power and phase coherence over the entire cortical sensor area were measured. After MRgFUS-capsulotomy, the high beta band power in the fronto-central and temporal areas decreased at 1 month and remained stable for 6 months. Cortical connectivity of the high beta band gradually decreased over the entire cortical area during the following 6 months. At 1 month, improvement in anxiety and depression symptoms was significantly correlated with changes in high beta band power in both the frontotemporal and temporal areas. The treatment effect of MRgFUS-capsulotomy may be attributed to the cortical high beta band. Our results provide an advanced understanding of the neural mechanisms underlying MRgFUS-capsulotomy and other neuromodulatory interventions for treatment-refractory OCD.
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Affiliation(s)
- Jhin Goo Chang
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, the Republic of Korea.
| | - Do-Won Kim
- School of Healthcare and Biomedical Engineering, Chonnam National University, Yeosu, the Republic of Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, the Republic of Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, the Republic of Korea
| | - Chan-Hyung Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, the Republic of Korea
| | - Se Joo Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, the Republic of Korea.
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, the Republic of Korea.
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12
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Transcranial Magnetic Stimulation in Obsessive-Compulsive Disorder. Psychiatr Clin North Am 2023; 46:133-166. [PMID: 36740349 DOI: 10.1016/j.psc.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Obsessive-compulsive disorder (OCD) patients need novel therapeutic interventions since most experience residual symptoms despite treatment. Converging evidence suggest that OCD involves dysfunction of limbic cortico-striato-thalamo-cortical loops, including the medial prefrontal cortex (mPFC) and dorsal anterior cingulate cortex (dACC), that tends to normalize with successful treatment. Recently, three repetitive transcranial magnetic stimulation (rTMS) coils were FDA-cleared for treatment-refractory OCD. This review presents on-label and off-label clinical evidence and relevant physical characteristics of the three coils. The Deep TMS™ H7 Coil studies' point to efficacy of mPFC-dACC stimulation, while no clear target stems from the small heterogenous D-B80 and figure-8 coils studies.
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13
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Shofty B, Gadot R, Provenza N, Storch EA, Goodman WK, Sheth SA. Neurosurgical Approaches for Treatment-Resistant Obsessive-Compulsive Disorder. Psychiatr Clin North Am 2023; 46:121-132. [PMID: 36740348 DOI: 10.1016/j.psc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Treatment-resistant obsessive-compulsive disorder (trOCD) is a severely disabling, life-threatening psychiatric disorder affecting ∼0.5% of the US population. Following the failure of multiple medical and psychotherapeutic treatment lines, patients with trOCD, like others with functional disorders, may benefit from invasive neuromodulation. Cumulative evidence suggests that disrupting abnormal hyperdirect cortico-striato-thalamo-cortical (CSTC) pathway activity offers sustainable, robust symptomatic relief in most patients. Multiple surgical approaches allow for modulation of the CSTC pathway, including stereotactic lesions and electrical stimulation. This review aims to describe the modern neurosurgical approaches for trOCD, recent advances in our understanding of pathophysiology, and future therapeutic directions.
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Affiliation(s)
- Ben Shofty
- Department of Neurosurgery, University of Utah, 175 North Medical Drive East, 5th Floor, Salt Lake City, UT 84132, USA
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street Suite 9A, Houston, TX 77030, USA
| | - Nicole Provenza
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street Suite 9A, Houston, TX 77030, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street Suite 9A, Houston, TX 77030, USA; Department of Psychiatry, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA.
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14
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Haber SN, Lehman J, Maffei C, Yendiki A. The rostral zona incerta: a subcortical integrative hub and potential DBS target for OCD. Biol Psychiatry 2023; 93:1010-1022. [PMID: 37055285 DOI: 10.1016/j.biopsych.2023.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/13/2022] [Accepted: 01/08/2023] [Indexed: 01/20/2023]
Abstract
BACKGROUND The zona incerta (ZI) is involved in mediating survival behaviors and is connected to a wide range of cortical and subcortical structures, including key basal ganglia nuclei. Based on these connections and their links to behavioral modulation, we propose that the ZI is a connectional hub for mediating between top-down and bottom-up control and a possible target for deep brain stimulation for obsessive-compulsive disorder. METHODS We analyzed the trajectory of cortical fibers to the ZI in nonhuman and human primates based on tracer injections in monkeys and high-resolution diffusion magnetic resonance imaging in humans. The organization of cortical and subcortical connections within the ZI were identified in the nonhuman primate studies. RESULTS Monkey anatomical data and human diffusion magnetic resonance imaging data showed a similar trajectory of fibers/streamlines to the ZI. Prefrontal cortex/anterior cingulate cortex terminals all converged within the rostral ZI, with dorsal and lateral areas being most prominent. Motor areas terminated caudally. Dense subcortical reciprocal connections included the thalamus, medial hypothalamus, substantia nigra/ventral tegmental area, reticular formation, and pedunculopontine nucleus and a dense nonreciprocal projection to the lateral habenula. Additional connections included the amygdala, dorsal raphe nucleus, and periaqueductal gray. CONCLUSIONS Dense connections with dorsal and lateral prefrontal cortex/anterior cingulate cortex cognitive control areas and the lateral habenula and the substantia nigra/ventral tegmental area, coupled with inputs from the amygdala, hypothalamus, and brainstem, suggest that the rostral ZI is a subcortical hub positioned to modulate between top-down and bottom-up control. A deep brain stimulation electrode placed in the rostral ZI would not only involve connections common to other deep brain stimulation sites but also capture several critically distinctive connections.
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Affiliation(s)
- Suzanne N Haber
- Department of Pharmacology & Physiology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
| | - Julia Lehman
- Department of Pharmacology & Physiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Chiara Maffei
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anastasia Yendiki
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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15
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Xue J, Qian D, Zhang B, Yang J, Li W, Bao Y, Qiu S, Fu Y, Wang S, Yuan TF, Lu W. Midbrain dopamine neurons arbiter OCD-like behavior. Proc Natl Acad Sci U S A 2022; 119:e2207545119. [PMID: 36343236 PMCID: PMC9674233 DOI: 10.1073/pnas.2207545119] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/28/2022] [Indexed: 08/19/2023] Open
Abstract
The neurobiological understanding of obsessive-compulsive disorder (OCD) includes dysregulated frontostriatal circuitry and altered monoamine transmission. Repetitive stereotyped behavior (e.g., grooming), a featured symptom in OCD, has been proposed to be associated with perturbed dopamine (DA) signaling. However, the precise brain circuits participating in DA's control over this behavioral phenotype remain elusive. Here, we identified that DA neurons in substantia nigra pars compacta (SNc) orchestrate ventromedial striatum (VMS) microcircuits as well as lateral orbitofrontal cortex (lOFC) during self-grooming behavior. SNc-VMS and SNc-lOFC dopaminergic projections modulate grooming behaviors and striatal microcircuit function differentially. Specifically, the activity of the SNc-VMS pathway promotes grooming via D1 receptors, whereas the activity of the SNc-lOFC pathway suppresses grooming via D2 receptors. SNc DA neuron activity thus controls the OCD-like behaviors via both striatal and cortical projections as dual gating. These results support both pharmacological and brain-stimulation treatments for OCD.
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Affiliation(s)
- Jinwen Xue
- Minister of Education (MOE) Key Laboratory of Developmental Genes and Human Disease, School of Life Science and Technology, Southeast University, Nanjing 210096, China
| | - Dandan Qian
- Minister of Education (MOE) Key Laboratory of Developmental Genes and Human Disease, School of Life Science and Technology, Southeast University, Nanjing 210096, China
| | - Bingqian Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jingxuan Yang
- Minister of Education (MOE) Key Laboratory of Developmental Genes and Human Disease, School of Life Science and Technology, Southeast University, Nanjing 210096, China
| | - Wei Li
- Minister of Education (MOE) Key Laboratory of Developmental Genes and Human Disease, School of Life Science and Technology, Southeast University, Nanjing 210096, China
| | - Yifei Bao
- Minister of Education (MOE) Key Laboratory of Developmental Genes and Human Disease, School of Life Science and Technology, Southeast University, Nanjing 210096, China
| | - Shi Qiu
- Minister of Education (MOE) Key Laboratory of Developmental Genes and Human Disease, School of Life Science and Technology, Southeast University, Nanjing 210096, China
| | - Yi Fu
- Minister of Education (MOE) Key Laboratory of Developmental Genes and Human Disease, School of Life Science and Technology, Southeast University, Nanjing 210096, China
| | - Shaoli Wang
- Minister of Education (MOE) Key Laboratory of Developmental Genes and Human Disease, School of Life Science and Technology, Southeast University, Nanjing 210096, China
- Department of Neurosurgery, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Shanghai Medical College of Fudan University, Shanghai 200032, China
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Wei Lu
- Minister of Education (MOE) Key Laboratory of Developmental Genes and Human Disease, School of Life Science and Technology, Southeast University, Nanjing 210096, China
- Department of Neurosurgery, Huashan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain Science, Shanghai Medical College of Fudan University, Shanghai 200032, China
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong 226001, China
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16
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Kassel MT, Lositsky O, Vaidya AR, Badre D, Malloy PF, Greenberg BD, Marsland R, Noren G, Sherman A, Rasmussen SA, McLaughlin NC. Differential assessment of frontally-mediated behaviors between self- and informant-report in patients with obsessive-compulsive disorder following gamma ventral capsulotomy. Neuropsychologia 2022; 170:108211. [DOI: 10.1016/j.neuropsychologia.2022.108211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 02/02/2022] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
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17
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Deep brain stimulation of the "medial forebrain bundle": a strategy to modulate the reward system and manage treatment-resistant depression. Mol Psychiatry 2022; 27:574-592. [PMID: 33903731 DOI: 10.1038/s41380-021-01100-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/21/2021] [Accepted: 04/01/2021] [Indexed: 02/02/2023]
Abstract
The medial forebrain bundle-a white matter pathway projecting from the ventral tegmental area-is a structure that has been under a lot of scrutinies recently due to its implications in the modulation of certain affective disorders such as major depression. In the following, we will discuss major depression in the context of being a disorder dependent on multiple relevant networks, the pathological performance of which is responsible for the manifestation of various symptoms of the disease which extend into emotional, motivational, physiological, and also cognitive domains of daily living. We will focus on the reward system, an evolutionarily conserved pathway whose underperformance leads to anhedonia and lack of motivation, which are key traits in depression. In the field of deep brain stimulation (DBS), different "hypothesis-driven" targets have been chosen as the subject of clinical trials on efficacy in the treatment-resistant depressed patient. The "medial forebrain bundle" is one such target for DBS, and has had remarkably rapid success in alleviating depressive symptoms, improving anhedonia and motivation. We will review what we have learned from pre-clinical animal studies on defining this white matter tract, its connectivity, and the complex molecular (i.e., neurotransmitter) mechanisms by which its modulation exerts its effects. Imaging studies in the form of tractographic depictions have elucidated its presence in the human brain. Such has led to ongoing clinical trials of DBS targeting this pathway to assess efficacy, which is promising yet still lack in sufficient numbers. Ultimately, one must confirm the mechanism of action and validate proof of antidepressant effect in order to have such treatment become mainstream, to promote widespread improvement in the quality of life of suffering patients.
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18
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Ahmari SE, Rauch SL. The prefrontal cortex and OCD. Neuropsychopharmacology 2022; 47:211-224. [PMID: 34400778 PMCID: PMC8617188 DOI: 10.1038/s41386-021-01130-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 01/03/2023]
Abstract
Obsessive Compulsive Disorder (OCD) is a highly prevalent and severe neuropsychiatric disorder, with an incidence of 1.5-3% worldwide. However, despite the clear public health burden of OCD and relatively well-defined symptom criteria, effective treatments are still limited, spotlighting the need for investigation of the neural substrates of the disorder. Human neuroimaging studies have consistently highlighted abnormal activity patterns in prefrontal cortex (PFC) regions and connected circuits in OCD during both symptom provocation and performance of neurocognitive tasks. Because of recent technical advances, these findings can now be leveraged to develop novel targeted interventions. Here we will highlight current theories regarding the role of the prefrontal cortex in the generation of OCD symptoms, discuss ways in which this knowledge can be used to improve treatments for this often disabling illness, and lay out challenges in the field for future study.
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Affiliation(s)
- Susanne E Ahmari
- Translational Neuroscience Program, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA.
- Center for the Neural Basis of Cognition, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Scott L Rauch
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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19
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Widge AS, Ellard KK, Paulk AC, Basu I, Yousefi A, Zorowitz S, Gilmour A, Afzal A, Deckersbach T, Cash SS, Kramer MA, Eden UT, Dougherty DD, Eskandar EN. Treating Refractory Mental Illness With Closed-Loop Brain Stimulation: Progress Towards a Patient-Specific Transdiagnostic Approach. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:137-151. [PMID: 35746936 PMCID: PMC9063604 DOI: 10.1176/appi.focus.20102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 07/25/2016] [Indexed: 01/03/2023]
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20
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Rasmussen SA, Goodman WK. The prefrontal cortex and neurosurgical treatment for intractable OCD. Neuropsychopharmacology 2022; 47:349-360. [PMID: 34433915 PMCID: PMC8616947 DOI: 10.1038/s41386-021-01149-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 01/03/2023]
Abstract
Over the past two decades, circuit-based neurosurgical procedures have gained increasing acceptance as a safe and efficacious approach to the treatment of the intractable obsessive-compulsive disorder (OCD). Lesions and deep brain stimulation (DBS) of the longitudinal corticofugal white matter tracts connecting the prefrontal cortex with the striatum, thalamus, subthalamic nucleus (STN), and brainstem implicate orbitofrontal, medial prefrontal, frontopolar, and ventrolateral cortical networks in the symptoms underlying OCD. The highly parallel distributed nature of these networks may explain the relative lack of adverse effects observed following surgery. Additional pre-post studies of cognitive tasks in more surgical patients are needed to confirm the role of these networks in OCD and to define therapeutic responses to surgical intervention.
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Affiliation(s)
- Steven A. Rasmussen
- grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI USA ,grid.40263.330000 0004 1936 9094Carney Brain Science Institute, Brown University, Providence, RI USA
| | - Wayne K. Goodman
- grid.39382.330000 0001 2160 926XMenninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
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21
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Contò F, Edwards G, Tyler S, Parrott D, Grossman E, Battelli L. Attention network modulation via tRNS correlates with attention gain. eLife 2021; 10:e63782. [PMID: 34826292 PMCID: PMC8626087 DOI: 10.7554/elife.63782] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/05/2021] [Indexed: 12/21/2022] Open
Abstract
Transcranial random noise stimulation (tRNS) can enhance vision in the healthy and diseased brain. Yet, the impact of multi-day tRNS on large-scale cortical networks is still unknown. We investigated the impact of tRNS coupled with behavioral training on resting-state functional connectivity and attention. We trained human subjects for 4 consecutive days on two attention tasks, while receiving tRNS over the intraparietal sulci, the middle temporal areas, or Sham stimulation. We measured resting-state functional connectivity of nodes of the dorsal and ventral attention network (DVAN) before and after training. We found a strong behavioral improvement and increased connectivity within the DVAN after parietal stimulation only. Crucially, behavioral improvement positively correlated with connectivity measures. We conclude changes in connectivity are a marker for the enduring effect of tRNS upon behavior. Our results suggest that tRNS has strong potential to augment cognitive capacity in healthy individuals and promote recovery in the neurological population.
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Affiliation(s)
- Federica Contò
- Center for Neuroscience and Cognitive Systems@UniTn, Istituto Italiano di TecnologiaRoveretoItaly
- Center for Mind/Brain Sciences, University of TrentoRoveretoItaly
| | - Grace Edwards
- Center for Neuroscience and Cognitive Systems@UniTn, Istituto Italiano di TecnologiaRoveretoItaly
- Department of Psychology, Harvard UniversityCambridgeUnited States
| | - Sarah Tyler
- Center for Neuroscience and Cognitive Systems@UniTn, Istituto Italiano di TecnologiaRoveretoItaly
- Butte CollegeOrovilleUnited States
| | - Danielle Parrott
- Center for Neuroscience and Cognitive Systems@UniTn, Istituto Italiano di TecnologiaRoveretoItaly
- Center for Mind/Brain Sciences, University of TrentoRoveretoItaly
| | - Emily Grossman
- Department of Cognitive Sciences, University of California, IrvineIrvineUnited States
| | - Lorella Battelli
- Center for Neuroscience and Cognitive Systems@UniTn, Istituto Italiano di TecnologiaRoveretoItaly
- Center for Mind/Brain Sciences, University of TrentoRoveretoItaly
- Department of Psychology, Harvard UniversityCambridgeUnited States
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel, Deaconess Medical Center, Harvard Medical SchoolBostonUnited States
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22
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Four Deep Brain Stimulation Targets for Obsessive-Compulsive Disorder: Are They Different? Biol Psychiatry 2021; 90:667-677. [PMID: 32951818 PMCID: PMC9569132 DOI: 10.1016/j.biopsych.2020.06.031] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/22/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
Deep brain stimulation is a promising therapeutic approach for patients with treatment-resistant obsessive-compulsive disorder, a condition linked to abnormalities in corticobasal ganglia networks. Effective targets are placed in one of four subcortical areas with the goal of capturing prefrontal, anterior cingulate, and basal ganglia connections linked to the limbic system. These include the anterior limb of the internal capsule, the ventral striatum, the subthalamic nucleus, and a midbrain target. The goal of this review is to examine these 4 targets with respect to the similarities and differences of their connections. Following a review of the connections for each target based on anatomic studies in nonhuman primates, we examine the accuracy of diffusion magnetic resonance imaging tractography to replicate those connections in nonhuman primates, before evaluating the connections in the human brain based on diffusion magnetic resonance imaging tractography. Results demonstrate that the four targets generally involve similar connections, all of which are part of the internal capsule. Nonetheless, some connections are unique to each site. Delineating the similarities and differences across targets is a critical step for evaluating and comparing the effectiveness of each and how circuits contribute to the therapeutic outcome. It also underscores the importance that the terminology used for each target accurately reflects its position and its anatomic connections, so as to enable comparisons across clinical studies and for basic scientists to probe mechanisms underlying deep brain stimulation.
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23
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de Oliveira KC, Camilo C, Gastaldi VD, Sant'Anna Feltrin A, Lisboa BCG, de Jesus Rodrigues de Paula V, Moretto AC, Lafer B, Hoexter MQ, Miguel EC, Maschietto M, Brentani H. Brain areas involved with obsessive-compulsive disorder present different DNA methylation modulation. BMC Genom Data 2021; 22:45. [PMID: 34717534 PMCID: PMC8557022 DOI: 10.1186/s12863-021-00993-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/29/2021] [Indexed: 12/13/2022] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts and repetitive actions, that presents the involvement of the cortico-striatal areas. The contribution of environmental risk factors to OCD development suggests that epigenetic mechanisms may contribute to its pathophysiology. DNA methylation changes and gene expression were evaluated in post-mortem brain tissues of the cortical (anterior cingulate gyrus and orbitofrontal cortex) and ventral striatum (nucleus accumbens, caudate nucleus and putamen) areas from eight OCD patients and eight matched controls. Results There were no differentially methylated CpG (cytosine-phosphate-guanine) sites (DMSs) in any brain area, nevertheless gene modules generated from CpG sites and protein-protein-interaction (PPI) showed enriched gene modules for all brain areas between OCD cases and controls. All brain areas but nucleus accumbens presented a predominantly hypomethylation pattern for the differentially methylated regions (DMRs). Although there were common transcriptional factors that targeted these DMRs, their targeted differentially expressed genes were different among all brain areas. The protein-protein interaction network based on methylation and gene expression data reported that all brain areas were enriched for G-protein signaling pathway, immune response, apoptosis and synapse biological processes but each brain area also presented enrichment of specific signaling pathways. Finally, OCD patients and controls did not present significant DNA methylation age differences. Conclusions DNA methylation changes in brain areas involved with OCD, especially those involved with genes related to synaptic plasticity and the immune system could mediate the action of genetic and environmental factors associated with OCD. Supplementary Information The online version contains supplementary material available at 10.1186/s12863-021-00993-0.
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Affiliation(s)
- Kátia Cristina de Oliveira
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785 - LIM23 (Térreo), São Paulo, 05403-010, Brazil.,Center of Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil.,Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Caroline Camilo
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785 - LIM23 (Térreo), São Paulo, 05403-010, Brazil.
| | - Vinícius Daguano Gastaldi
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785 - LIM23 (Térreo), São Paulo, 05403-010, Brazil
| | - Arthur Sant'Anna Feltrin
- Center of Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Bianca Cristina Garcia Lisboa
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785 - LIM23 (Térreo), São Paulo, 05403-010, Brazil
| | - Vanessa de Jesus Rodrigues de Paula
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785 - LIM23 (Térreo), São Paulo, 05403-010, Brazil
| | | | - Beny Lafer
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785 - LIM23 (Térreo), São Paulo, 05403-010, Brazil
| | - Marcelo Queiroz Hoexter
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785 - LIM23 (Térreo), São Paulo, 05403-010, Brazil.,Laboratório de Psicopatologia e Terapêutica Psiquiátrica (LIM23), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Euripedes Constantino Miguel
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785 - LIM23 (Térreo), São Paulo, 05403-010, Brazil.,Laboratório de Psicopatologia e Terapêutica Psiquiátrica (LIM23), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Helena Brentani
- Departamento & Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Ovídio Pires de Campos, 785 - LIM23 (Térreo), São Paulo, 05403-010, Brazil.,Laboratório de Psicopatologia e Terapêutica Psiquiátrica (LIM23), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
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24
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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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25
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Kent B, Rossa C. Electric impedance spectroscopy feature extraction for tissue classification with electrode embedded surgical needles through a modified forward stepwise method. Comput Biol Med 2021; 135:104522. [PMID: 34153792 DOI: 10.1016/j.compbiomed.2021.104522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
There has been a growing interest in developing electric impedance sensing surgical tools for tissue identification during surgery. A key facet of this development is identifying distinct features that can be used to identify tissues from one another. This paper explores several feature extraction techniques and classification methods applied to electric impedance data. Furthermore, a modified forward stepwise method is proposed. The method introduces a scoring metric to help select features to add to the model, that is based off of the coefficient of variation and overlapping index from the feature's probability density functions for each of the classes. The proposed and existing methods were applied to spectral data measured at 23 frequencies, from 132 samples across 6 different tissues including ex-vivo bovine kidney, liver and muscle, poultry liver, as well as freshly excised canine testicle and ovary samples. These methods were able to successfully find impedance spectra features for the investigated biological tissues. The best predictive accuracy was with Boruta feature extraction and a Random Forest classifier but without significantly reducing the number of features in the classifier model. The proposed method was able to reduce the number of features in the model to an average of 5.8 features for all tested classifiers. These methods may have use in finding features to discriminate other tissue types, possibly to aid in targeting lesions in minimally invasive cancer treatment surgeries.
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Affiliation(s)
- B Kent
- Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada.
| | - C Rossa
- Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON L1G 0C5, Canada.
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26
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Pittenger C, Brennan BP, Koran L, Mathews CA, Nestadt G, Pato M, Phillips KA, Rodriguez CI, Simpson HB, Skapinakis P, Stein DJ, Storch EA. Specialty knowledge and competency standards for pharmacotherapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 300:113853. [PMID: 33975093 PMCID: PMC8536398 DOI: 10.1016/j.psychres.2021.113853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
Obsessive-compulsive disorder (OCD) affects approximately one person in 40 and causes substantial suffering. Evidence-based treatments can benefit many; however, optimal treatment can be difficult to access. Diagnosis is frequently delayed, and pharmacological and psychotherapeutic interventions often fail to follow evidence-based guidelines. To ameliorate this distressing situation, the International OCD Accreditation Task Force of the Canadian Institute for Obsessive-Compulsive Disorders has developed knowledge and competency standards for specialized treatments for OCD through the lifespan. These are foundational to evidence-based practice and will form the basis for upcoming ATF development of certification/accreditation programs. Here, we present specialty standards for the pharmacological treatment of adult OCD. We emphasize the importance of integrating pharmacotherapy with clear diagnosis, appreciation of complicating factors, and evidence-based cognitive behavioral therapy. Clear evidence exists to inform first- and second-line pharmacological treatments. In disease refractory to these initial efforts, multiple strategies have been investigated, but the evidence is more equivocal. These standards summarize this limited evidence to give the specialist practitioner a solid basis on which to make difficult decisions in complex cases. It is hoped that further research will lead to development of a clear, multi-step treatment algorithm to support each step in clinical decision-making.
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Affiliation(s)
- Christopher Pittenger
- Department of Psychiatry and Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States.
| | - Brian P Brennan
- Biological Psychiatry Laboratory and Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Lorrin Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michele Pato
- Institute for Genomic Health and Department of Psychiatry, SUNY Downstate College of Medicine, Brooklyn, NY, United States
| | - Katharine A Phillips
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, and Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - H Blair Simpson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Office of Mental Health, Research Foundation for Mental Hygiene, New York Psychiatric Institute, New York, NY, United States
| | - Petros Skapinakis
- Department of Psychiatry, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
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27
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van Westen M, Rietveld E, Bergfeld IO, de Koning P, Vullink N, Ooms P, Graat I, Liebrand L, van den Munckhof P, Schuurman R, Denys D. Optimizing Deep Brain Stimulation Parameters in Obsessive-Compulsive Disorder. Neuromodulation 2021; 24:307-315. [PMID: 33128489 PMCID: PMC7984355 DOI: 10.1111/ner.13243] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/22/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Deep brain stimulation (DBS) is an innovative and effective treatment for patients with therapy-refractory obsessive-compulsive disorder (OCD). DBS offers unique opportunities for personalized care, but no guidelines on how to choose effective and safe stimulation parameters in patients with OCD are available. Our group gained relevant practical knowledge on DBS optimization by treating more than 80 OCD patients since 2005, the world's largest cohort. The article's objective is to share this experience. MATERIALS AND METHODS We provide guiding principles for optimizing DBS stimulation parameters in OCD and discuss the neurobiological and clinical basis. RESULTS Adjustments in stimulation parameters are performed in a fixed order. First, electrode contact activation is determined by the position of the electrodes on postoperative imaging. Second, voltage and pulse width are increased stepwise, enlarging both the chance of symptom reduction and of inducing side effects. Clinical evaluation of adjustments in stimulation parameters needs to take into account: 1) the particular temporal sequence in which the various OCD symptoms and DBS side-effects change; 2) the lack of robust response predictors; 3) the limited sensitivity of the Yale-Brown Obsessive-Compulsive Scale to assess DBS-induced changes in OCD symptoms; and 4) a patient's fitness for additional cognitive-behavioral therapy (CBT). CONCLUSIONS Decision-making in stimulation parameter optimization needs to be sensitive to the particular time-courses on which various symptoms and side effects change.
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Affiliation(s)
- Maarten van Westen
- Department of PsychiatryAmsterdam UMC, University of AmsterdamMeibergdreef9AmsterdamThe Netherlands
| | - Erik Rietveld
- Department of PsychiatryAmsterdam UMC, University of AmsterdamMeibergdreef9AmsterdamThe Netherlands
| | - Isidoor O. Bergfeld
- Department of PsychiatryAmsterdam UMC, University of AmsterdamMeibergdreef9AmsterdamThe Netherlands
| | - Pelle de Koning
- Department of PsychiatryAmsterdam UMC, University of AmsterdamMeibergdreef9AmsterdamThe Netherlands
| | - Nienke Vullink
- Department of PsychiatryAmsterdam UMC, University of AmsterdamMeibergdreef9AmsterdamThe Netherlands
| | - Pieter Ooms
- Department of PsychiatryAmsterdam UMC, University of AmsterdamMeibergdreef9AmsterdamThe Netherlands
| | - Ilse Graat
- Department of PsychiatryAmsterdam UMC, University of AmsterdamMeibergdreef9AmsterdamThe Netherlands
| | - Luka Liebrand
- Department of PsychiatryAmsterdam UMC, University of AmsterdamMeibergdreef9AmsterdamThe Netherlands
- Department of Biomedical Engineering & PhysicsAmsterdam UMC, University of AmsterdamMeibergdreef9AmsterdamThe Netherlands
| | - Pepijn van den Munckhof
- Department of NeurosurgeryAmsterdam UMC, University of AmsterdamMeibergdreef9AmsterdamThe Netherlands
| | - Rick Schuurman
- Department of NeurosurgeryAmsterdam UMC, University of AmsterdamMeibergdreef9AmsterdamThe Netherlands
| | - Damiaan Denys
- Department of PsychiatryAmsterdam UMC, University of AmsterdamMeibergdreef9AmsterdamThe Netherlands
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28
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Sui Y, Tian Y, Ko WKD, Wang Z, Jia F, Horn A, De Ridder D, Choi KS, Bari AA, Wang S, Hamani C, Baker KB, Machado AG, Aziz TZ, Fonoff ET, Kühn AA, Bergman H, Sanger T, Liu H, Haber SN, Li L. Deep Brain Stimulation Initiative: Toward Innovative Technology, New Disease Indications, and Approaches to Current and Future Clinical Challenges in Neuromodulation Therapy. Front Neurol 2021; 11:597451. [PMID: 33584498 PMCID: PMC7876228 DOI: 10.3389/fneur.2020.597451] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/23/2020] [Indexed: 01/17/2023] Open
Abstract
Deep brain stimulation (DBS) is one of the most important clinical therapies for neurological disorders. DBS also has great potential to become a great tool for clinical neuroscience research. Recently, the National Engineering Laboratory for Neuromodulation at Tsinghua University held an international Deep Brain Stimulation Initiative workshop to discuss the cutting-edge technological achievements and clinical applications of DBS. We specifically addressed new clinical approaches and challenges in DBS for movement disorders (Parkinson's disease and dystonia), clinical application toward neurorehabilitation for stroke, and the progress and challenges toward DBS for neuropsychiatric disorders. This review highlighted key developments in (1) neuroimaging, with advancements in 3-Tesla magnetic resonance imaging DBS compatibility for exploration of brain network mechanisms; (2) novel DBS recording capabilities for uncovering disease pathophysiology; and (3) overcoming global healthcare burdens with online-based DBS programming technology for connecting patient communities. The successful event marks a milestone for global collaborative opportunities in clinical development of neuromodulation to treat major neurological disorders.
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Affiliation(s)
- Yanan Sui
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Ye Tian
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Wai Kin Daniel Ko
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Zhiyan Wang
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Fumin Jia
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Andreas Horn
- Charité, Department of Neurology, Movement Disorders and Neuromodulation Unit, University Medicine Berlin, Berlin, Germany
| | - Dirk De Ridder
- Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ki Sueng Choi
- Department of Psychiatry and Behavioural Science, Emory University, Atlanta, GA, United States.,Department of Radiology, Mount Sinai School of Medicine, New York, NY, United States.,Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, United States
| | - Ausaf A Bari
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - Shouyan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Kenneth B Baker
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Andre G Machado
- Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Tipu Z Aziz
- Department of Neurosurgery, John Radcliffe Hospital, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Erich Talamoni Fonoff
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.,Hospital Sírio-Libanês and Hospital Albert Einstein, São Paulo, Brazil
| | - Andrea A Kühn
- Charité, Department of Neurology, Movement Disorders and Neuromodulation Unit, University Medicine Berlin, Berlin, Germany
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada (IMRIC), Faculty of Medicine, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research (ELSC), The Hebrew University and Department of Neurosurgery, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Terence Sanger
- University of Southern California, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Hesheng Liu
- Department of Neuroscience, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Suzanne N Haber
- Department of Pharmacology and Physiology, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States.,McLean Hospital and Harvard Medical School, Belmont, MA, United States
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
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29
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Abstract
Obsessive-compulsive disorder (OCD) is a common, chronic, and oftentimes disabling disorder. The only established first-line treatments for OCD are exposure and response prevention, and serotonin reuptake inhibitor medications (SRIs). However, a subset of patients fails to respond to either modality, and few experience complete remission. Beyond SRI monotherapy, antipsychotic augmentation is the only medication approach for OCD with substantial empirical support. Our incomplete understanding of the neurobiology of OCD has hampered efforts to develop new treatments or enhance extant interventions. This review focuses on several promising areas of research that may help elucidate the pathophysiology of OCD and advance treatment. Multiple studies support a significant genetic contribution to OCD, but pinpointing the specific genetic determinants requires additional investigation. The preferential efficacy of SRIs in OCD has neither led to discovery of serotonergic abnormalities in OCD nor to development of new serotonergic medications for OCD. Several lines of preclinical and clinical evidence suggest dysfunction of the glutamatergic system in OCD, prompting testing of several promising glutamate modulating agents. Functional imaging studies in OCD show consistent evidence for increased activity in brain regions that form a cortico-striato-thalamo-cortical (CSTC) loop. Neuromodulation treatments with either noninvasive devices (e.g., transcranial magnetic stimulation) or invasive procedures (e.g., deep brain stimulation) provide further support for the CSTC model of OCD. A common substrate for various interventions (whether drug, behavioral, or device) may be modulation (at different nodes or connections) of the CSTC circuit that mediates the symptoms of OCD.
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Affiliation(s)
- Wayne K. Goodman
- Menninger Department of Psychiatry and Behavioral Sciences (all authors) and Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences (all authors) and Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
| | - Sameer A. Sheth
- Menninger Department of Psychiatry and Behavioral Sciences (all authors) and Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
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30
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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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31
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Chang KW, Jung HH, Chang JW. Magnetic Resonance-Guided Focused Ultrasound Surgery for Obsessive-Compulsive Disorders: Potential for use as a Novel Ablative Surgical Technique. Front Psychiatry 2021; 12:640832. [PMID: 33889100 PMCID: PMC8057302 DOI: 10.3389/fpsyt.2021.640832] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/11/2021] [Indexed: 12/24/2022] Open
Abstract
Surgical treatment for psychiatric disorders, such as obsessive-compulsive disorder (OCD) and depression, using ablative techniques, such as cingulotomy and capsulotomy, have historically been controversial for a number of scientific, social, and ethical reasons. Recently, with the elucidation of anatomical and neurochemical substrates of brain function in healthy controls and patients with such disorders using various functional neuroimaging techniques, these criticisms are becoming less valid. Furthermore, by using new techniques, such as deep brain stimulation (DBS), and identifying more precise targets, beneficial effects and the lack of serious complications have been demonstrated in patients with psychiatric disorders. However, DBS also has many disadvantages. Currently, magnetic resonance-guided focused ultrasound surgery (MRgFUS) is used as a minimal-invasive surgical method for generating precisely placed focal thermal lesions in the brain. Here, we review surgical techniques and their potential complications, along with anterior limb of the internal capsule (ALIC) capsulotomy by radiofrequency lesioning and gamma knife radiosurgery, for the treatment of OCD and depression. We also discuss the limitations and technical issues related to ALIC capsulotomy with MRgFUS for medically refractory OCD and depression. Through this review we hope MRgFUS could be considered as a new treatment choice for refractory OCD.
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Affiliation(s)
- Kyung Won Chang
- Department of Neurosurgery & Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Ho Jung
- Department of Neurosurgery & Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Chang
- Department of Neurosurgery & Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
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32
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Chabardes S, Krack P, Piallat B, Bougerol T, Seigneuret E, Yelnik J, Fernandez Vidal S, David O, Mallet L, Benabid AL, Polosan M. Deep brain stimulation of the subthalamic nucleus in obsessive-compulsives disorders: long-term follow-up of an open, prospective, observational cohort. J Neurol Neurosurg Psychiatry 2020; 91:1349-1356. [PMID: 33033168 PMCID: PMC7677463 DOI: 10.1136/jnnp-2020-323421] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/01/2020] [Accepted: 08/31/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a major cause of disability in western country and responsible for severe impairment of quality of life. About 10% of patients present with severe OCD symptoms and require innovative treatment such as deep brain stimulation (DBS). Among possible targets, the non-motor subthalamic nucleus (STN) is a key node of the basal ganglia circuitry, strongly connected to limbic cortical areas known to be involved in OCD. METHOD We analysed, in a prospective, observational, monocentric, open label cohort, the effect of chronic non-motor STN-DBS in 19 patients with treatment-resistant OCD consecutively operated in a single centre. Severity of OCD was evaluated using the Yale and Brown Obsessive-Compulsive Scale (YBOCS). YBOCS scores at 6, 12 and 24 months postoperatively were compared with baseline. Responders were defined by >35% improvement of YBOCS scores. Global Assessment Functioning (GAF) scale was used to evaluate the impact of improvement. RESULTS At a 24-month follow-up, the mean YBOCS score improved by 53.4% from 33.3±3.5 to 15.8±9.1 (95% CI 11.2-20.4; p<0.0001). Fourteen out of 19 patients were considered as responders, 5 out of 19 being improved over 75% and 10 out of 19 over 50%. GAF scale improved by 92% from 34.1±3.9 to 66.4±18.8 (95% CI 56.7-76.1; p=0.0003). The most frequent adverse events consisted of transient DBS-induced hypomania and anxiety. CONCLUSION Chronic DBS of the non-motor STN is an effective and relatively safe procedure to treat severe OCD resistant to conventional management.
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Affiliation(s)
- Stephan Chabardes
- CLINATEC, CEA Clinatec-Minatec, Grenoble, France .,Department of Neurosurgery, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.,Grenoble Institut neurosciences, University Grenoble Alpes-INSERM U1216, 38000 Grenoble, France
| | - Paul Krack
- Division of Neurology, Department of Neurology, Bern University Hospital, Bern, Switzerland, Bern, Switzerland.,Department of Neurology, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Brigitte Piallat
- Grenoble Institut neurosciences, University Grenoble Alpes-INSERM U1216, 38000 Grenoble, France
| | - Thierry Bougerol
- Department of Psychiatry, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Eric Seigneuret
- Department of Neurosurgery, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Jerome Yelnik
- Institut du Cerveau, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | - Sara Fernandez Vidal
- Institut du Cerveau, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France
| | - Olivier David
- Grenoble Institut neurosciences, University Grenoble Alpes-INSERM U1216, 38000 Grenoble, France
| | - Luc Mallet
- Institut du Cerveau, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France.,Département Médical-Universitaire de Psychiatrie et d'Addictologie, Univ Paris-Est Créteil, DMU IMPACT, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France.,Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | | | - Mircea Polosan
- Grenoble Institut neurosciences, University Grenoble Alpes-INSERM U1216, 38000 Grenoble, France.,Department of Psychiatry, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
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33
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Matsumoto J, Fukunaga M, Miura K, Nemoto K, Koshiyama D, Okada N, Morita K, Yamamori H, Yasuda Y, Fujimoto M, Hasegawa N, Watanabe Y, Kasai K, Hashimoto R. Relationship between white matter microstructure and work hours. Neurosci Lett 2020; 740:135428. [PMID: 33086092 DOI: 10.1016/j.neulet.2020.135428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/12/2020] [Accepted: 10/01/2020] [Indexed: 11/18/2022]
Abstract
Human social activities are realized by a synergy of neuronal activity over various regions of the brain, which is supported by their connectivity. In the present study, we examined associations between social activities, represented by work hours, and brain connectivity as quantified using diffusion tensor imaging (DTI). In 483 healthy participants, DTI analysis was performed using 3 T magnetic resonance imaging, and work hours were calculated, considering hours of paid employment (the "Work for Pay" category), hours of housework (the "Work at Home" category), and hours of school-related study (the "Student" category). The correlations between each class of work time and DTI indices were analyzed. The mean diffusivity (MD) values of the anterior limb of the internal capsule (ALIC) and the superior fronto-occipital fasciculus (SFO) were negatively correlated with total work hours (ALIC: r = -0.192, p = 2.3 × 10-5; SFO: r = -0.161, p = 3.8 × 10-4). We also found that the MD values of the ALIC and the SFO were correlated with work hours in the Work for Pay category (ALIC: r = -0.211, p = 3.2 × 10-6; SFO: r = -0.163, p = 3.4 × 10-4) but not with those in the Work at Home category or the Student category. These results suggest that social activity is associated with the white matter microstructure of the ALIC and the SFO. The main difference between "Work for Pay" and the other two social activities appears to be the type of motivation-for example, external versus internal. Therefore, the white matter microstructure of the ALIC and SFO may be related to externally motivated social activities.
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Affiliation(s)
- Junya Matsumoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8553, Japan
| | - Masaki Fukunaga
- Division of Cerebral Integration, National Institute for Physiological Sciences, 38 Nishigonaka Myodaiji, Okazaki, Aichi 444-8585, Japan
| | - Kenichiro Miura
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8553, Japan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Daisuke Koshiyama
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naohiro Okada
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; The International Research Center for Neurointelligence (WPI-IRCN) at University of Tokyo Institutes for Advanced Study (UTIAS), 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kentaro Morita
- Department of Rehabilitation, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hidenaga Yamamori
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8553, Japan; Japan Community Health Care Organization Osaka Hospital, 4-2-78 Fukushima, Fukushima-ku, Osaka, Osaka 553-0003, Japan; Department of Psychiatry, Osaka University, Graduate School of Medicine, D3, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yuka Yasuda
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8553, Japan; Medical Corporation Foster, 1-3-11, Oyodominami, Kita-ku, Osaka, Osaka, 531-0075, Japan
| | - Michiko Fujimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8553, Japan; Department of Psychiatry, Osaka University, Graduate School of Medicine, D3, 2-2, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Naomi Hasegawa
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8553, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan, Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; The International Research Center for Neurointelligence (WPI-IRCN) at University of Tokyo Institutes for Advanced Study (UTIAS), 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ryota Hashimoto
- Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashi, Kodaira, Tokyo 187-8553, Japan; Osaka University, 1-1 Yamadaoka, Suita, Osaka 565-0871, Japan.
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Peker S, Samanci MY, Yilmaz M, Sengoz M, Ulku N, Ogel K. Efficacy and Safety of Gamma Ventral Capsulotomy for Treatment-Resistant Obsessive-Compulsive Disorder: A Single-Center Experience. World Neurosurg 2020; 141:e941-e952. [PMID: 32565377 DOI: 10.1016/j.wneu.2020.06.098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a chronic disease with a lifetime prevalence of 3% and is associated with severe impairment in familial and socio-occupational functioning. Gamma ventral capsulotomy (GVC) is a treatment choice in carefully chosen patients, with few published reports. In this study, we aimed to report the efficacy and safety of GVC in 21 patients with treatment-resistant OCD. METHODS This is a retrospective single-center study. Twenty-one patients meeting the selection criteria were included. Patients were considered responders if there were ≥35% reduction in post-GVC Yale-Brown Obsessive Compulsive Scale scores and considered in remission if scores were ≤8. The mean and median clinical follow-up durations were 60.7 and 56 months, respectively (range, 38-149 months). RESULTS The mean baseline Yale-Brown Obsessive Compulsive Scale score of 35.7 (n = 21) decreased to 15.3 (n = 20) at 36 months follow-up evaluation (P < 0.0001). Fifteen patients (75%) achieved a full response. Of those patients, 7 (35%) were considered to be in remission. There were no partial responders, and 5 patients (25%) were classified as nonresponders. The pre-GVC mean Beck Depression Inventory-II score of 35.1 (n = 21) decreased to 13.8 (n = 20) at 36 months follow-up evaluation (P < 0.0001). Three patients (14.3%) had a transient post-GVC headache that resolved within a week, and 2 patients (9.5%) had persistent headaches that responded to 2-week oral corticosteroid treatment. A brain cyst developed after GVC in 2 patients (10%). No clinically notable abnormalities were seen on neurologic examination at any follow-up. CONCLUSIONS Gamma ventral capsulotomy is a reasonable treatment method in select patients with treatment-resistant OCD.
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Affiliation(s)
- Selçuk Peker
- Department of Neurosurgery, School of Medicine, Koç University, Istanbul, Turkey.
| | | | - Meltem Yilmaz
- Department of Medical Biotechnology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Meric Sengoz
- Department of Radiation Oncology, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Nazan Ulku
- Department of Psychology, Acıbadem Kozyatağı Hospital, Istanbul, Turkey
| | - Kültegin Ogel
- Department of Psychiatry, Health Sciences Institute, Istanbul Bilgi University, Istanbul, Turkey
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Lv Q, Lv Q, Yin D, Zhang C, Sun B, Voon V, Wang Z. Neuroanatomical Substrates and Predictors of Response to Capsulotomy in Intractable Obsessive-Compulsive Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:29-38. [PMID: 32653579 DOI: 10.1016/j.bpsc.2020.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/27/2020] [Accepted: 05/12/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Anterior capsulotomy that surgically targets fiber tracts connecting prefrontal cortex and subcortical nuclei is a therapeutic option for a subgroup of patients with treatment-refractory obsessive-compulsive disorder. The goal of this study was to investigate neural correlates to anterior capsulotomy and find predictors of clinical improvement following this procedure. METHODS Structural and diffusion imaging data and clinical evaluation were acquired from 31 patients with refractory obsessive-compulsive disorder who underwent anterior capsulotomy. Of the 31 patients, 16 were clinical responders defined by a ≥35% reduction in the Yale-Brown Obsessive Compulsive Scale scores. Analysis of variance was applied on 2 levels (surgery and response) to examine alterations of gray matter volume and fiber tract integrity (measured by generalized fractional anisotropy). The correlation between preoperative data and clinical response was further investigated. RESULTS After surgery, generalized fractional anisotropy was significantly decreased in the bilateral anterior limb of the internal capsule and anterior thalamic radiation, accompanied by a decrease in gray matter volume in the prefrontal cortex, anterior cingulate cortex, striatum, thalamus, and cerebellum. Moreover, atrophy of the right caudate was greater in responders than in nonresponders, which correlated with alteration in Yale-Brown Obsessive Compulsive Scale score. In addition, preoperative gray matter volume in the right inferior frontal gyrus and generalized fractional anisotropy in the left superior longitudinal fasciculus and right cingulum predicted improved response. More anterior location of the lesion area predicted better clinical response. CONCLUSIONS These results demonstrate that reduced volume of the right caudate might be associated with therapeutic response of capsulotomy and might offer a potential predictor of treatment outcome and a guide for lesion site.
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Affiliation(s)
- Qian Lv
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Qiming Lv
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Dazhi Yin
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
| | - Zheng Wang
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Key Laboratory of Primate Neurobiology, Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China; University of the Chinese Academy of Sciences, Beijing, China; Shanghai Center for Brain Science and Brain-Inspired Intelligence Technology, Shanghai, China.
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Douw L, Quaak M, Fitzsimmons SM, de Wit SJ, van der Werf YD, van den Heuvel OA, Vriend C. Static and dynamic network properties of the repetitive transcranial magnetic stimulation target predict changes in emotion regulation in obsessive-compulsive disorder. Brain Stimul 2020; 13:318-326. [DOI: 10.1016/j.brs.2019.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 01/23/2023] Open
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Park J, Kim T, Kim M, Lee TY, Kwon JS. Functional Connectivity of the Striatum as a Neural Correlate of Symptom Severity in Patient with Obsessive-Compulsive Disorder. Psychiatry Investig 2020; 17:87-95. [PMID: 32000480 PMCID: PMC7047004 DOI: 10.30773/pi.2019.0206] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/13/2019] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE It is well established that the cortico-striato-thalamo-cortical (CSTC) circuit is implicated in the pathophysiology of obsessive- compulsive disorder (OCD). However, reports on corticostriatal functional connectivity (FC) in OCD have been inconsistent due to the structural and functional heterogeneity of the striatum. Therefore, in the present study, we investigated corticostriatal FC using a fine 12-seed striatal parcellation to overcome this heterogeneity and discover the neural correlates of symptoms in OCD patients. METHODS We recruited 23 OCD patients and 23 healthy controls (HCs). Whole-brain FC based on striatal seeds was examined using resting-state functional magnetic resonance imaging data and compared across OCD patients and HCs. We conducted correlation analysis between FCs of striatal subregions with significant group differences and symptom severity scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Rating Scale for Depression, and Hamilton Rating Scale for Anxiety (HAM-A). RESULTS Compared to HCs, patients demonstrated increased FC of the dorsal caudal putamen and ventral rostral putamen (VRP) with several cortical regions, such as the intracalcarine cortex, inferior frontal gyrus, supramarginal/angular gyrus (SMG/AG), and postcentral gyrus (PCG). Furthermore, FC between the VRP and SMG/AG and between the VRP and PCG was negatively correlated with scores on the Y-BOCS compulsive subscale and the HAM-A, respectively. CONCLUSION These findings suggest that striatal subregions have strengthened FC with extensive cortical regions, which may reflect neural correlates of compulsive and anxious symptoms in OCD patients. These results contribute to an improved understanding of OCD pathophysiology by complementing the current evidence regarding striatal FC.
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Affiliation(s)
- Junha Park
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Taekwan Kim
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Tae Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jun Soo Kwon
- Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, Seoul National University-Medical Research Center, Seoul, Republic of Korea
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Coenen VA, Schlaepfer TE, Sajonz B, Döbrössy M, Kaller CP, Urbach H, Reisert M. Tractographic description of major subcortical projection pathways passing the anterior limb of the internal capsule. Corticopetal organization of networks relevant for psychiatric disorders. Neuroimage Clin 2020; 25:102165. [PMID: 31954987 PMCID: PMC6965747 DOI: 10.1016/j.nicl.2020.102165] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/06/2019] [Accepted: 01/09/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Major depression (MD) and obsessive-compulsive disorder (OCD) are psychiatric diseases with a huge impact on individual well-being. Despite optimal treatment regiments a subgroup of patients remains treatment resistant and stereotactic surgery (stereotactic lesion surgery, SLS or Deep Brain Stimulation, DBS) might be an option. Recent research has described four networks related to MD and OCD (affect, reward, cognitive control, default network) but only on a cortical and the adjacent sub-cortical level. Despite the enormous impact of comparative neuroanatomy, animal science and stereotactic approaches a holistic theory of subcortical and cortical network interactions is elusive. Because of the dominant hierarchical rank of the neocortex, corticofugal approaches have been used to identify connections in subcortical anatomy without anatomical priors and in part confusing results. We here propose a different corticopetal approach by identifying subcortical networks and search for neocortical convergences thereby following the principle of phylogenetic and ontogenetic network development. MATERIAL AND METHODS This work used a diffusion tensor imaging data from a normative cohort (Human Connectome Project, HCP; n = 200) to describe eight subcortical fiber projection pathways (PPs) from subthalamic nucleus (STN), substantia nigra (SNR), red nucleus (RN), ventral tegmental area (VTA), ventrolateral thalamus (VLT) and mediodorsal thalamus (MDT) in a normative space (MNI). Subcortical and cortical convergences were described including an assignment of the specific pathways to MD/OCD-related networks. Volumes of activated tissue for different stereotactic stimulation sites and procedures were simulated to understand the role of the distinct networks, with respect to symptoms and treatment of OCD and MD. RESULTS The detailed course of eight subcortical PPs (stnPP, snrPP, rnPP, vlATR, vlATRc, mdATR, mdATRc, vtaPP/slMFB) were described together with their subcortical and cortical convergences. The anterior limb of the internal capsule can be subdivided with respect to network occurrences in ventral-dorsal and medio-lateral gradients. Simulation of stereotactic procedures for OCD and MD showed dominant involvement of mdATR/mdATRc (affect network) and vtaPP/slMFB (reward network). DISCUSSION Corticofugal search strategies for the evaluation of stereotactic approaches without anatomical priors often lead to confusing results which do not allow for a clear assignment of a procedure to an involved network. According to our simulation of stereotactic procedures in the treatment of OCD and MD, most of the target regions directly involve the reward (and affect) networks, while side-effects can in part be explained with a co-modulation of the control network. CONCLUSION The here proposed corticopetal approach of a hierarchical description of 8 subcortical PPs with subcortical and cortical convergences represents a new systematics of networks found in all different evolutionary and distinct parts of the human brain.
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Affiliation(s)
- Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center and Medical Faculty of Freiburg University, Breisacher Strasse 64, Freiburg im Breisgau 79106, Germany; Center for Basics in Neuromodulation, Freiburg University, Germany.
| | - Thomas E Schlaepfer
- Department of Interventional Biological Psychiatry, Freiburg University Medical Center and Medical Faculty of Freiburg University, Germany
| | - Bastian Sajonz
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center and Medical Faculty of Freiburg University, Breisacher Strasse 64, Freiburg im Breisgau 79106, Germany
| | - Máté Döbrössy
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center and Medical Faculty of Freiburg University, Breisacher Strasse 64, Freiburg im Breisgau 79106, Germany
| | - Christoph P Kaller
- Department of Neuroradiology, Freiburg University Medical Center and Medical Faculty of Freiburg University, Germany
| | - Horst Urbach
- Department of Neuroradiology, Freiburg University Medical Center and Medical Faculty of Freiburg University, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center and Medical Faculty of Freiburg University, Breisacher Strasse 64, Freiburg im Breisgau 79106, Germany
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Zhang C, Zhang Y, Li D, Deng Z, Nuttin B, Voon V, Sun B. Habenular Stimulation for Neurosurgery Resistant Obsessive-Compulsive Disorder: A Case Report. Front Psychiatry 2020; 11:29. [PMID: 32116846 PMCID: PMC7025519 DOI: 10.3389/fpsyt.2020.00029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Some patients suffer from persistent and severely disabling Obsessive-Compulsive Disorder (OCD) symptoms that cannot be alleviated by conventional treatments or neuroablative interventions targeting cortico-striatal loop circuits. Currently, it is unclear how to manage the clinical symptoms of these unique patients. We reasoned that deep brain stimulation (DBS) of the habenula (HB) could be a valuable subsequent treatment option for these otherwise medically intractable cases of severe OCD. The HB is an epithalamic structure critically involved in the encoding and responding to aversive stimulus events, cognitive and brain processes known to be impaired in many patients with OCD. Similarly, HB DBS can alleviate depression and anxiety, which often co-occur with OCD. Here, we explore the clinical benefits and risks of HB DBS treatment in a patient with severe and refractory OCD. CASE PRESENTATION A 30-year-old male patient presented with persistent and severely disabling OCD symptoms that were refractory to previous psychological and pharmacological treatments as well as to neuroablative surgical interventions involving both capsulotomy and cingulotomy. After HB DBS, however, the severity of the patient's OCD symptoms was markedly reduced at 1-month follow-up, which was sustained until the final (at 12-month) follow-up. The patient also reported enduring improvements in depression, anxiety, and health-related quality of life after several months of HB DBS treatment. CONCLUSIONS This case report provides the first clinical evidence suggesting that HB DBS could serve as a safe and effective alternative neurosurgical intervention for severe and refractory OCD. The present findings are promising and warrant further research into the role of the HB in pathophysiology and treatment of OCD.
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Affiliation(s)
- Chencheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yingying Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhengdao Deng
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Nuttin
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Holland MT, Trapp NT, McCormick LM, Jareczek FJ, Zanaty M, Close LN, Beeghly J, Greenlee JDW. Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Long Term Naturalistic Follow Up Study in a Single Institution. Front Psychiatry 2020; 11:55. [PMID: 32184741 PMCID: PMC7058594 DOI: 10.3389/fpsyt.2020.00055] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/22/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) is a proven, effective tool in the treatment of movement disorders. Expansion of indications for DBS into the realm of neuropsychiatric disorders, especially obsessive-compulsive disorder (OCD), has gained fervent interest, although data on appropriate clinical utilization remains limited. METHODS A retrospective, naturalistic study followed nine severely affected OCD patients (average YBOCs score before implantation 34.2 ± 2.5) treated with DBS of ventral capsule/ventral striatum, with average follow up of 54.8 months. RESULTS With chronic stimulation (years), a majority of the patients achieved significant benefits in obsessive-compulsive and depressive symptoms. Six patients experienced periods of OCD remission following implantation. Four of the six responders required more than 12 months to achieve response. Relief of major depressive symptoms occurred in four out of six patients with documented co-morbid depression. Settings required to achieve efficacy were higher than those typically utilized for movement disorders, necessitating increased impulse generator (IPG) battery demand. We found patients benefited from conversion to a rechargeable IPG to prevent serial operations for IPG replacement. For patients with rechargeable IPGs, the repetitive habit of recharging did not appear to aggravate or trigger new obsessive-compulsive behaviors or anxiety symptoms. CONCLUSIONS Our study supports and builds upon other research suggesting that DBS for OCD in a real-world setting can be implemented successfully and provide long-term benefit for severely affected OCD patients. Optimal patient selection and DBS programming criteria are discussed. The use of rechargeable IPGs appears to be both cost effective and well-tolerated in this population.
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Affiliation(s)
- Marshall T Holland
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Nicholas T Trapp
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Laurie M McCormick
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States.,Rein Center: Emotional Health and Well-Being, Iowa City, IA, United States
| | | | - Mario Zanaty
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Liesl N Close
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - James Beeghly
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Jeremy D W Greenlee
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
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Obsessive-Compulsive Disorder: Lesions. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Maatoug R, Valero-Cabré A, Duriez P, Saudreau B, Fernández-Vidal S, Karachi C, Millet B. Sustained Recovery in a Treatment-Refractory Obsessive-Compulsive Disorder Patient After Deep Brain Stimulation Battery Failure. Front Psychiatry 2020; 11:572059. [PMID: 33281642 PMCID: PMC7691224 DOI: 10.3389/fpsyt.2020.572059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a widespread chronic neuropsychiatric disorder characterized by recurrent intrusive thoughts, images, or urges (obsessions) that typically cause anxiety or distress. Even when optimal treatment is provided, 10% of patients remain severely affected chronically. In some countries, deep brain stimulation (DBS) is an approved and effective therapy for patients suffering from treatment-resistant OCD. Hereafter, we report the case of a middle-aged man with a long history of treatment-resistant OCD spanning nearly a decade with Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores oscillating between 21 and 28. The patient underwent bilateral implantation of ventral striatum/ventral capsule DBS leads attached to a battery-operated implanted pulse generator. After a 3-month postimplantation period, the DBS protocol started. Three months after the onset of DBS treatment, the patient's Y-BOCS score had dropped to 3, and he became steadily asymptomatic. However, inadvertently, at this time, it was found out that the implanted pulse generator battery had discharged completely, interrupting brain stimulation. The medical team carried on with the original therapeutic and evaluation plan in the absence of active DBS current. After 12 additional months under off-DBS, the patient remained at a Y-BOCS score of 7 and asymptomatic. To our knowledge, this is the first report that provides an opportunity to discuss four different hypotheses of long-term recovery induced by DBS in a treatment-refractory OCD patient, notably: (1) A placebo effect; (2) Paradoxical improvements induced by micro-lesions generated by DBS probe implantation procedures; (3) Unexpected late spontaneous improvements; (4) Recovery driven by a combination of active DBS-induction, the effects of medication, and DBS-placebo effects.
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Affiliation(s)
- Redwan Maatoug
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, Paris, France
| | - Antoni Valero-Cabré
- Groupe de Dynamiques Cérébrales, Plasticité et Rééducation and Frontlab Team, Institut du Cerveau (ICM), INSERM 1127, CNRS, UMR 7225 and Sorbonne Université (SO), Paris, France.,Institut du Cerveau et de la Moelle Epinière (ICM), CNRS UMR 7225, INSERM U 1127, Sorbonne Université, Paris, France.,Laboratory for Cerebral Dynamics Plasticity and Rehabilitation, Boston University, School of Medicine, Boston, MA, United States.,Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Spain
| | - Philibert Duriez
- Institute of Psychiatry and Neurosciences of Paris, Unité Mixte de Recherche en Santé (UMRS) 1266 Institut National de la Santé et de la Recherche Médicale (INSERM), University Paris Descartes, Paris, France.,Clinique des Maladies Mentales et de l'Encéphale, Groupement Hospitalier Universitaire (GHU) Paris Psychiatry and Neuroscience, Sainte-Anne Hospital, Paris, France
| | - Bertrand Saudreau
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, Paris, France
| | - Sara Fernández-Vidal
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau (CRICM), UMR-S975, Paris, France.,INSERM, U975, Paris, France.,CNRS, UMR 7225, CR-ICM, Paris, France.,Centre de Neuroimagerie de Recherche de l'Institut du Cerveau (CENIR ICM), Paris, France
| | - Carine Karachi
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau (CRICM), UMR-S975, Paris, France.,INSERM, U975, Paris, France.,CNRS, UMR 7225, CR-ICM, Paris, France.,Neurosurgery Department, APHP, Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Paris, France
| | - Bruno Millet
- Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, Paris, France
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43
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Dell'Osso B, Cremaschi L, Oldani L, Altamura AC. New Directions in the Use of Brain Stimulation Interventions in Patients with Obsessive-Compulsive Disorder. Curr Med Chem 2019; 25:5712-5721. [PMID: 28474552 DOI: 10.2174/0929867324666170505113631] [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: 09/29/2016] [Revised: 03/20/2017] [Accepted: 04/23/2017] [Indexed: 01/03/2023]
Abstract
Obsessive-Compulsive Disorder (OCD) is a highly disabling condition with early onset and chronic course in most of the affected patients. In addition, OCD may show high comorbidity and suicide attempt rates, which worsen the overall burden of the disease for patients and their caregivers. First-line treatments for OCD consist of pro-serotonergic compounds and cognitive-behavioral therapy. Nonetheless, many patients show only limited benefit from such interventions and require additional "next-step" interventions, including augmentative antipsychotics and glutamate-modulating agents. Based on the knowledge about altered neurocircuitry in OCD, brain stimulation techniques, including transcranial magnetic and electrical stimulations (TMS and tDCS) and deep brain stimulation (DBS), have been increasingly investigated over the last decade, revealing positive results for otherwise intractable and treatment-refractory patients. Available evidence in the field is in continuous evolution and professionals actively involved in the management of OCD patients, psychiatrists in particular, need to be updated about latest developments. Through the analysis of controlled studies, meta-analyses, and International treatment guidelines, the present article is aimed at providing the state of the art on the use of brain stimulation techniques for the treatment of OCD.
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Affiliation(s)
- Bernardo Dell'Osso
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, CA, United States
| | - Laura Cremaschi
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Lucio Oldani
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Carlo Altamura
- Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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44
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Barcia JA, Reneses B, Nombela C. Precision surgery for obsessive compulsive disorder-which is the proper target? ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S184. [PMID: 31656763 DOI: 10.21037/atm.2019.07.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Juan Antonio Barcia
- Department of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Blanca Reneses
- Department of Psychiatry, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Nombela
- Department of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
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45
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Stein DJ, Costa DLC, Lochner C, Miguel EC, Reddy YCJ, Shavitt RG, van den Heuvel OA, Simpson HB. Obsessive-compulsive disorder. Nat Rev Dis Primers 2019; 5:52. [PMID: 31371720 PMCID: PMC7370844 DOI: 10.1038/s41572-019-0102-3] [Citation(s) in RCA: 333] [Impact Index Per Article: 66.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2019] [Indexed: 12/15/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the 'obsessive-compulsive and related disorders', a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive-behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
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Affiliation(s)
- Dan J Stein
- Department of Psychiatry, University of Cape Town and SA MRC Unit on Risk & Resilience in Mental Disorders, Cape Town, South Africa.
| | - Daniel L C Costa
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Christine Lochner
- Department of Psychiatry, Stellenbosch University and SA MRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch, South Africa
| | - Euripedes C Miguel
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Roseli G Shavitt
- OCD Research Program, Instituto de Psiquiatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
- Department of Anatomy & Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - H Blair Simpson
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
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46
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Park HR, Kim IH, Kang H, McCairn KW, Lee DS, Kim BN, Kim DG, Paek SH. Electrophysiological and imaging evidence of sustained inhibition in limbic and frontal networks following deep brain stimulation for treatment refractory obsessive compulsive disorder. PLoS One 2019; 14:e0219578. [PMID: 31323037 PMCID: PMC6641158 DOI: 10.1371/journal.pone.0219578] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/26/2019] [Indexed: 01/05/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that arises from a complex interaction of environmental and genetic factors. Despite numerous pharmacological and behavioral interventions, approximately 10% of patients remain refractory. High-frequency deep brain stimulation (HF-DBS) has shown promising results for treatment-refractory OCD. We report the follow-up result of up to 6 years of 4 treatment-refractory OCD patients treated by HF-DBS. Targets of stimulation were the anterior limb of the internal capsule (ALIC) in two cases, and the nucleus accumbens (NAc) in the remaining cohort. The clinical profiles were quantified by the Yale-Brown obsessive-compulsive scale (Y-BOCS). Highly significant reductions in Y-BOCS scores were obtained from all patients during the follow-up period. A greater that 90% reduction in Y-BOCS, observed in the most successful case, was achieved with NAc HF-DBS. Y-BOCS scores in the other patients consistently achieved over 50% reductions in OCD symptoms. FDG-PET imaging indicated post-surgical reductions in metabolism, in not only targeted limbic networks, but also other frontal cortical and subcortical regions, suggesting that large-scale network modulation and inhibitions are associated with functional recovery in OCD. This study demonstrates that HF-DBS targeted to the ALIC and NAc is a safe and effective method for ameliorating intractable, treatment-refractory OCD symptoms. The NAc appeared to be the superior target for symptom reduction, and local inhibition of NAc activity and reduced frontal metabolism are key therapeutic indications.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - In Hyang Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Korea
| | - Hyejin Kang
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kevin W. McCairn
- Systems Neuroscience Section, Primate Research Institute, Kyoto University, Inuyama, Aichi, Japan
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Bung-Nyun Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, Korea
| | - Dong Gyu Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- * E-mail:
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47
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Santos BFDO, Gorgulho A, Saraiva CWC, Lopes AC, Gomes JGR, Pássaro AM, Hoexter MQ, Miguel EC, De Salles AAF. Understanding gamma ventral capsulotomy: Potential implications of diffusion tensor image tractography on target selectivity. Surg Neurol Int 2019; 10:136. [PMID: 31528471 PMCID: PMC6744751 DOI: 10.25259/sni-65-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/15/2019] [Indexed: 11/25/2022] Open
Abstract
Background: The role of tractography in gamma ventral capsulotomy (GVC) planning is still unclear. This paper aims to describe the spatial distribution of medial orbitofrontal cortex (OFC) and lateral OFC fibers passing through the anterior limb of the internal capsule (ALIC) and analyze quantitative tractography parameters that differentiate obsessive-compulsive disorder (OCD) individuals from other neurosurgery functional patients (morbid obesity and Parkinson’s disease [PD]). Methods: Twenty patients undergoing functional stereotactic procedures, between 2013 and 2016, were included in this study. OCD patients underwent GVC (single shot 150 Gy and 4-mm collimators). PD and morbid obesity patients were submitted to deep brain stimulation implants. Diffusion tensor image tractography was reconstructed using Brainlab Elements software (Brainlab AG, Munich, Germany). Results: Nine PD, six morbid obesity, and five OCD patients were included with a mean age of 65.4 ± 9.1, 41.0 ± 8.2, and 31.2 ± 5.5, respectively, which are statistically different from each other (P < 0.001). Fourteen patients (70%) were men. A total of 40 cerebral hemispheres were analyzed. Medial OFC fibers are localized more inferior in the ALIC than the lateral OFC fibers in all hemispheres, but the level of intersection and exact topography of fiber bundles are variable among individuals. Both medial and lateral OFC fiber tracts of PD and morbid obesity patients have lower volume than, respectively, medial and lateral counterparts of OCD patients (P < 0.001). Conclusions: Medial and lateral OFC tract fibers have a general standard distribution in the anterior internal capsule (lateral OFC higher than medial OFC fibers). There are differences between obesity, Parkinson, and OCD patients regarding fiber tract statistics.
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Affiliation(s)
- Bruno Fernandes de Oliveira Santos
- Department of Neurosurgery and Radiotherapy, Hospital do Coracao (HCOR Neurosciences), Gamma Knife.,Departament of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alessandra Gorgulho
- Department of Neurosurgery and Radiotherapy, Hospital do Coracao (HCOR Neurosciences), Gamma Knife.,Departament of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Crystian W C Saraiva
- Department of Neurosurgery and Radiotherapy, Hospital do Coracao (HCOR Neurosciences), Gamma Knife
| | - Antonio Carlos Lopes
- Departament of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Anderson M Pássaro
- Department of Neurosurgery and Radiotherapy, Hospital do Coracao (HCOR Neurosciences), Gamma Knife
| | - Marcelo Q Hoexter
- Departament of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Eurípedes C Miguel
- Departament of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Antonio A F De Salles
- Department of Neurosurgery and Radiotherapy, Hospital do Coracao (HCOR Neurosciences), Gamma Knife.,Departament of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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48
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Versace A, Graur S, Greenberg T, Lima Santos JP, Chase HW, Bonar L, Stiffler RS, Hudak R, Kim T, Yendiki A, Greenberg B, Rasmussen S, Liu H, Haber S, Phillips ML. Reduced focal fiber collinearity in the cingulum bundle in adults with obsessive-compulsive disorder. Neuropsychopharmacology 2019; 44:1182-1188. [PMID: 30802896 PMCID: PMC6784994 DOI: 10.1038/s41386-019-0353-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/17/2019] [Accepted: 02/04/2019] [Indexed: 12/31/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a disabling condition, often associated with a chronic course. Given its role in attentional control, decision-making, and emotional regulation, the anterior cingulate cortex is considered to have a key role in the pathophysiology of the disorder. Notably, the cingulum bundle, being the major white matter tract connecting to this region, has been historically a target for the surgical treatment of intractable OCD. In this study, we aimed to identify the extent to which focal-more than diffuse-abnormalities in fiber collinearity of the cingulum bundle could distinguish 48 adults with OCD (mean age [SD] = 23.3 [4.5] years; F/M = 30/18) from 45 age- and sex-matched healthy control adults (CONT; mean age [SD] = 23.2 [3.8] years; F/M = 28/17) and further examine if these abnormalities correlated with symptom severity. Use of tract-profiles rather than a conventional diffusion imaging approach allowed us to characterize white matter microstructural properties along (100 segments), as opposed to averaging these measures across, the entire tract. To account for these 100 different segments of the cingulum bundle, a repeated measures analysis of variance revealed a main effect of group (OCD < CONT; F[1,87] = 5.3; P = 0.024) upon fractional anisotropy (FA, a measure of fiber collinearity and/or white matter integrity), in the cingulum bundle, bilaterally. Further analyses revealed that these abnormalities were focal (middle portion) within the left and right cingulum bundle, although did not correlate with symptom severity in OCD. Findings indicate that focal abnormalities in connectivity between the anterior cingulate cortex and other prefrontal cortical regions may represent neural mechanisms of OCD.
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Affiliation(s)
- A. Versace
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA USA
| | - S. Graur
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA USA
| | - T. Greenberg
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA USA
| | - J. P. Lima Santos
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA USA
| | - H. W. Chase
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA USA
| | - L. Bonar
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA USA
| | - R. S. Stiffler
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA USA
| | - R. Hudak
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA USA
| | - Tae Kim
- 0000 0004 1936 9000grid.21925.3dDepartment of Radiology, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA USA
| | - A. Yendiki
- 000000041936754Xgrid.38142.3cAthinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - B. Greenberg
- 0000 0004 0420 4094grid.413904.bDepartment of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital and Providence VA Medical Center, Providence, RI USA
| | - S. Rasmussen
- 0000 0004 0420 4094grid.413904.bDepartment of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital and Providence VA Medical Center, Providence, RI USA
| | - H. Liu
- 000000041936754Xgrid.38142.3cAthinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - S. Haber
- 0000 0004 1936 9166grid.412750.5Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, NY 14642 USA
| | - M. L. Phillips
- 0000 0004 1936 9000grid.21925.3dDepartment of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA USA
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Li Y, Zhang CC, Kathrin Weidacker, Zhang Y, He N, Jin H, Chen W, Voon V, Edden RAE, Yan F. Investigation of anterior cingulate cortex gamma-aminobutyric acid and glutamate-glutamine levels in obsessive-compulsive disorder using magnetic resonance spectroscopy. BMC Psychiatry 2019; 19:164. [PMID: 31146727 PMCID: PMC6543571 DOI: 10.1186/s12888-019-2160-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 05/23/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a relatively common and disabling psychiatric disorder whose pathophysiology is incompletely understood. In this study, we utilized magnetic resonance spectroscopy (MRS) in an effort to provide a better understanding of the role of brain gamma-aminobutyric acid (GABA) and glutamate in the pathophysiology of OCD. We hypothesized that beyond the separate effects of these neurotransmitter systems, a disruption in the balance between GABA and glutamate could be particularly relevant to OCD. METHODS We obtained MRS measures of GABA and glutamate concentrations in the anterior cingulate cortex from 23 adult patients with OCD and 20 sex- and age-matched healthy community volunteers. Established clinical rating scales were used to assess the severities of OCD, anxiety, and depression symptoms. Statistical analysis involved the assessment of patient-control group differences in the individual measures of GABA and glutamate, as well as in the ratio of the GABA to glutamate measures. Additionally, we explored whether differences in the MRS measures existed between two subgroups of patients formed according to the severity of their OCD symptoms. Finally, we assessed the relations of demographic and clinical variables to the MRS measures. RESULTS Patients with OCD displayed a higher estimated GABA level and a higher GABA to glutamate ratio than healthy participants, but no significant group differences were observed in the measure of glutamate. The MRS measures did not vary by subgroup and showed no correlations with demographic and clinical variables. CONCLUSIONS These results indicate that GABA abnormalities within the anterior cingulate cortex contribute to the pathophysiology of OCD. The results fail to provide evidence that glutamate abnormalities alone are involved in adult OCD. Yet, it seems that a disruption in the balance between glutamate and GABA neurotransmission may have a particularly important role to play in OCD pathophysiology.
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Affiliation(s)
- Yan Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chen Cheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | - Yingying Zhang
- Department of Functional Neurosurgery, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haiyan Jin
- Department of Psychiatry, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Richard A E Edden
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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50
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Marques RC, Vieira L, Marques D, Cantilino A. Transcranial magnetic stimulation of the medial prefrontal cortex for psychiatric disorders: a systematic review. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2019; 41:447-457. [PMID: 31166547 PMCID: PMC6796817 DOI: 10.1590/1516-4446-2019-0344] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/31/2019] [Indexed: 03/11/2023]
Abstract
OBJECTIVE The medial prefrontal cortex (mPFC) is a highly connected cortical region that acts as a hub in major large-scale brain networks. Its dysfunction is associated with a number of psychiatric disorders, such as schizophrenia, autism, depression, substance use disorder (SUD), obsessive-compulsive disorder (OCD), and anxiety disorders. Repetitive transcranial magnetic stimulation (rTMS) studies targeting the mPFC indicate that it may be a useful therapeutic resource in psychiatry due to its selective modulation of this area and connected regions. METHODS This review examines six mPFC rTMS trials selected from 697 initial search results. We discuss the main results, technical and methodological details, safety, tolerability, and localization strategies. RESULTS Six different protocols were identified, including inhibitory (1 Hz) and excitatory (5, 10, and 20 Hz) frequencies applied therapeutically to patient populations diagnosed with major depressive disorder, OCD, autistic spectrum disorder, SUD, specific phobia, and post-traumatic stress disorder (PTSD). In the OCD and acrophobia trials, rTMS significantly reduced symptoms compared to placebo. CONCLUSION These protocols were considered safe and add interesting new evidence to the growing body of mPFC rTMS literature. However, the small number and low methodological quality of the studies indicate the need for further research.
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Affiliation(s)
- Rodrigo C. Marques
- Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, UFPE, Recife, PE, Brazil
| | - Larissa Vieira
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, UFPE, Recife, PE, Brazil
- Laboratório de Neurociência Aplicada, UFPE, Recife, PE, Brazil
| | - Déborah Marques
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, UFPE, Recife, PE, Brazil
- Laboratório de Neurociência Aplicada, UFPE, Recife, PE, Brazil
| | - Amaury Cantilino
- Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
- Programa de Pós-Graduação em Neuropsiquiatria e Ciências do Comportamento, UFPE, Recife, PE, Brazil
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