Amygdala DBS for PTSD: 2 years of observations on the first case

Koek, Ralph J.; Langevin, Jean-Philippe; Krahl, Scott E.; Chen, J.W.Y.; Kulick, Alexis D.; Schwartz, Holly N; Mandelkern, M.; Sultzer, David L.

doi:10.1016/j.brs.2017.01.086

Cited by 8 publications

(7 citation statements)

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“…Langevin et al [73, 74] and Koek et al [75, 76] described a combat veteran who despite 20 years of pharmacological and psychological treatment remained severely symptomatic. His baseline clinician-administered PTSD scale (CAPS) score was 119, classifying his PTSD as extremely severe.…”

Section: Resultsmentioning

confidence: 99%

“…This approach allowed for a DBS lead placement that spanned the central nucleus of the amygdala, the BLa, and the head of the HPC [74]. Substantial clinical improvement was reported 8 months postoperatively, with a reduction in CAPS score to 74 (37.8% reduction) and at 15 months a reduction to 62 (48% reduction) [73, 75]. Stimulation parameters were 1.4 V, 60 μs, 160 Hz on the right side and 0.7 V, 60 μs, and 160 Hz on the left side.…”

Section: Resultsmentioning

confidence: 99%

“…Table 2 details DBS for PTSD in human clinical research, comprising 6 publications on 3 individual patients, summarized below. One pilot trial of DBS of the BLa [72] has resulted so far in 2 published cases with 4 years follow-up for one of the 2 operated patients [73][74][75][76][77]. The authors' rationale for targeting the BLa was based on one hand on the reported rat model research, and on the other hand on human imaging studies using fMRI, positron emission tomography and single-photon emission computed tomography showing that when patients with PTSD are exposed to imagery or audio related to their trauma, the BLa is hyperactive compared to healthy controls [37].…”

Section: Clinical Research Resultsmentioning

confidence: 99%

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Deep Brain Stimulation for Post-Traumatic Stress Disorder: A Review of the Experimental and Clinical Literature

Meeres¹,

Hariz

2022

Stereotact Funct Neurosurg

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Introduction: Up to 30% of patients with post-traumatic stress disorder (PTSD), especially combat veterans, remain refractory to conventional treatment. For them, deep brain stimulation (DBS) has been suggested. Here, we review the literature on animal models of PTSD in which DBS has been used to treat PTSD-type behavior, and we review and discuss patient reports of DBS for PTSD. Methods: A broad search was performed to find experimental animal articles and clinical reports on PubMed, Ovid MEDLINE, Cochrane Library, and PsycINFO, using combinations and variations of search words pertinent to DBS and PTSD. Results: The search yielded 30 articles, 24 on DBS in rat models of PTSD, and 6 publications between 2016 and 2020 reporting on a total of 3 patients. DBS in rat models targeted 4 brain areas: medial prefrontal cortex (mPFC), ventral striatum, amygdala, and hippocampus. Clinical publications reported on 2 male combat veterans who received DBS in basolateral amygdala, and 1 female with PTSD due to domestic abuse, who received DBS of mPFC. All 3 patients benefitted to various extents from DBS, at follow-ups of 4 years, 6 months, and 7 months, respectively. Conclusions: PTSD is the only potential clinical indication for DBS that shows extensive animal research prior to human applications. Nevertheless, DBS for PTSD remains highly investigational. Despite several years of government funding of DBS research in view of treating severe PTSD in combat veterans, ethical dilemmas, recruitment difficulties, and issues related to use of DBS in such a complex and heterogenous disorder remain prevalent.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Clinical Research Resultsmentioning

confidence: 99%

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Deep Brain Stimulation for Post-Traumatic Stress Disorder: A Review of the Experimental and Clinical Literature

Meeres¹,

Hariz

2022

Stereotact Funct Neurosurg

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“…The amygdala is also involved in behavioral disorders including aggression, addiction, anxiety, substance abuse, epilepsy, and post-traumatic stress disorder (PTSD) 2-6 . The functional characterization of amygdala circuitry in humans is foundational for the understanding of these neuropsychiatric diseases and for developing new neuromodulatory treatments targeting the amygdala circuit [7][8][9] . The functional and structural configuration of the amygdala circuit has been extensively described in the literature but mainly focused on the parcellation of the amygdala with still paucity of descriptions of its main white matter (WM) bundles [10][11][12][13][14][15][16] .…”

mentioning

confidence: 99%

Connectivity-based parcellation of the amygdala and identification of its main white matter connections

Avecillas-Chasín

Levinson

Kuhn

et al. 2023

Sci Rep

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The amygdala plays a role in emotion, learning, and memory and has been implicated in behavioral disorders. Better understanding of the amygdala circuitry is crucial to develop new therapies for these disorders. We used data from 200 healthy-subjects from the human connectome project. Using probabilistic tractography, we created population statistical maps of amygdala connectivity to brain regions involved in limbic, associative, memory, and reward circuits. Based on the amygdala connectivity with these regions, we applied k-means clustering to parcellate the amygdala into three clusters. The resultant clusters were averaged across all subjects and the main white-matter pathways of the amygdala from each averaged cluster were generated. Amygdala parcellation into three clusters showed a medial-to-lateral pattern. The medial cluster corresponded with the centromedial and cortical nuclei, the basal cluster with the basal nuclei and the lateral cluster with the lateral nuclei. The connectivity analysis revealed different white-matter pathways consistent with the anatomy of the amygdala circuit. This in vivo connectivity-based parcellation of the amygdala delineates three clusters of the amygdala in a mediolateral pattern based on its connectivity with brain areas involved in cognition, memory, emotion, and reward. The human amygdala circuit presented in this work provides the first step for personalized amygdala circuit mapping for patients with behavioral disorders.

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“…As a result, metabolic hyperactivity of the BLA characterize symptomatic episodes in PTSD patients [3]. We are using deep brain stimulation (DBS) in PTSD subjects to modulate the activity of the BLA and promote fear extinction [4]. Targeted focal neuromodulation offers a unique opportunity to gain new insights into the circuitry of emotion in PTSD patients.…”

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confidence: 99%

Structural correlates of emotional response to electrical stimulation of the amygdala in subjects with PTSD

et al. 2020

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Amygdala DBS for PTSD: 2 years of observations on the first case

Cited by 8 publications

References 0 publications

Deep Brain Stimulation for Post-Traumatic Stress Disorder: A Review of the Experimental and Clinical Literature

Deep Brain Stimulation for Post-Traumatic Stress Disorder: A Review of the Experimental and Clinical Literature

Connectivity-based parcellation of the amygdala and identification of its main white matter connections

Structural correlates of emotional response to electrical stimulation of the amygdala in subjects with PTSD

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