Acute deep brain stimulation changes in regional cerebral blood flow in obsessive-compulsive disorder

被引：26
作者：
Dougherty, Darin D. [1 ,2 ]
Chou, Tina [1 ,2 ,3 ]
Corse, Andrew K. [1 ,2 ]
Arulpragasam, Amanda R. [1 ,2 ]
Widge, Alik S. [1 ,2 ,4 ]
Cusin, Cristina [1 ,2 ]
Evans, Karleyton C. [1 ,2 ]
Greenberg, Benjamin D. [5 ,6 ]
Haber, Suzanne N. [7 ]
Deckersbach, Thilo [1 ,2 ]
机构：
[1] Massachusetts Gen Hosp, Dept Psychiat, Div Neurotherapeut, Charlestown, MA USA
[2] Harvard Med Sch, Charlestown, MA USA
[3] Harvard Univ, Dept Psychol, Cambridge, MA 02138 USA
[4] MIT, Picower Inst Learning & Memory, 77 Massachusetts Ave, Cambridge, MA 02139 USA
[5] Butler Hosp, Dept Psychiat & Behav Sci, Providence, RI 02906 USA
[6] Brown Med Sch, Providence, RI USA
[7] Univ Rochester, Med Ctr, Dept Physiol & Pharmacol, Rochester, NY 14642 USA
来源：
JOURNAL OF NEUROSURGERY | 2016年 / 125卷 / 05期
基金：
美国国家科学基金会;
关键词：
deep brain stimulation; positron emission tomography; obsessive-compulsive disorder; ventral capsule/ventral striatum; cortico-striatal-thalamic-cortical circuit; functional neurosurgery; VOLUME;
D O I：
10.3171/2015.9.JNS151387
中图分类号：
R74 [神经病学与精神病学];
学科分类号：
摘要：
OBJECTIVE Deep brain stimulation (DBS) is a reversible, nonlesion-based treatment for patients with intractable obsessive-compulsive disorder (OCD). The first studies on DBS for OCD stimulating the ventral capsule/ventral striatum (VC/VS) yielded encouraging results for this neuroanatomical site's therapeutic efficacy. This investigation was conducted to better understand which regions of the cortico-striatal-thalamic-cortical network were acutely affected by VC/VS DBS for OCD. Furthermore, the objective was to identify which brain regions demonstrated changes in perfusion, as stimulation was applied across a dorsoventral lead axis that corresponded to different anatomical locations in the VC/VS. METHODS Six patients receiving VC/VS DBS for OCD underwent oxygen-15 positron emission tomography (O-15-PET) scanning. Monopolar DBS was delivered at each of the 4 different electrodes on the stimulating lead in the VC/VS. The data were analyzed using SPM5. Paired t-tests were run in SPSS to identify significant changes in regional cerebral blood flow (rCBF) between stimulation conditions. Pearson's r correlations were run between these significant changes in rCBF and changes in OCD and depressive symptom severity. RESULTS Perfusion in the dorsal anterior cingulate cortex (dACC) significantly increased when monopolar DBS was turned on at the most ventral DBS contact, and this increase in dACC activity was correlated with reductions in depressive symptom severity (r(5) = -0.994, p = 0.001). Perfusion in the thalamus, striatum, and globus pallidus significantly increased when DBS was turned on at the most dorsal contact. CONCLUSIONS DBS of the VC/VS appears to modulate activity in the regions implicated in the pathophysiology of OCD. Different regions in the cortico-striatal-thalamic-cortical circuit showed increased perfusion based on whether the stimulation was more ventral or dorsal along the lead axis in the VC/VS. Evidence was found that DBS at the most ventral site was associated with clinical changes in depressive symptom severity, but not OCD symptom severity.
引用
收藏
页码：1087 / 1093
页数：7
相关论文
共 22 条
[1]  
BAXTER LR, 1992, ARCH GEN PSYCHIAT, V49, P681
[2]  
Brett M., 2002, NEUROIMAGE, V16, P497, DOI DOI 10.1016/S1053-8119(02)90013-3
[3]  
First M, 2002, STRUCTURED CLIN INTE
[4]   Decrease in thalamic volumes of pediatric patients with obsessive-compulsive disorder who are taking paroxetine [J].
Gilbert, AR ;
Moore, GJ ;
Keshavan, MS ;
Paulson, LAD ;
Narula, V ;
MacMaster, FP ;
Stewart, CM ;
Rosenberg, DR .
ARCHIVES OF GENERAL PSYCHIATRY, 2000, 57 (05) :449-456
[5]  
GOODMAN WK, 1989, ARCH GEN PSYCHIAT, V46, P1006
[6]   Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience [J].
Greenberg, B. D. ;
Gabriels, L. A. ;
Malone, D. A., Jr. ;
Rezai, A. R. ;
Friehs, G. M. ;
Okun, M. S. ;
Shapira, N. A. ;
Foote, K. D. ;
Cosyns, P. R. ;
Kubu, C. S. ;
Malloy, P. F. ;
Salloway, S. P. ;
Giftakis, J. E. ;
Rise, M. T. ;
Machado, A. G. ;
Baker, K. B. ;
Stypulkowski, P. H. ;
Goodman, W. K. ;
Rasmussen, S. A. ;
Nuttin, B. J. .
MOLECULAR PSYCHIATRY, 2010, 15 (01) :64-79
[7]   Neurosurgery for intractable obsessive-compulsive disorder and depression: critical issues [J].
Greenberg, BD ;
Price, LH ;
Rauch, SL ;
Friehs, G ;
Noren, G ;
Malone, D ;
Carpenter, LL ;
Rezai, AR ;
Rasmussen, SA .
NEUROSURGERY CLINICS OF NORTH AMERICA, 2003, 14 (02) :199-+
[8]   Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder [J].
Greenberg B.D. ;
Malone D.A. ;
Friehs G.M. ;
Rezai A.R. ;
Kubu C.S. ;
Malloy P.F. ;
Salloway S.P. ;
Okun M.S. ;
Goodman W.K. ;
Rasmussen S.A. .
Neuropsychopharmacology, 2006, 31 (11) :2384-2393
[9]   Obsessive-compulsive disorder [J].
Jenike, MA .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (03) :259-265
[10]  
Jenike MA, 1996, ARCH GEN PSYCHIAT, V53, P625
123