Compulsions, Parkinson's disease, and stimulation

Deep brain stimulation in Parkinson disease—what went wrong?

“…Attempts to refine the optimal target for DBS have led to exploration of the NAcc, the ventral striatum and the bed nucleus of the stria terminalis (Figure 2) [101][102][103], with beneficial effects observed in all of these target regions (Table S2 in the supplementary material online). Serendipitous observations revealed that DBS in the STN had a beneficial effect on comorbid OCD symptoms in three PD patients [104,105]. This effect was the opposite to what would have been expected from animal experiments showing that STN inactivation led to impulse control disorder, which could be considered OCD-like behaviour [106].…”

A three-dimensional, histological and deformable atlas of the human basal ganglia. I. Atlas construction based on immunohistochemical and MRI data

“…(For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.) mood responses are obtained by stimulation of different parts of the STN in human parkinsonian patients (MacKinnon et al, 2005;Mallet et al, 2002;Stefurak et al, 2003). However, it must be remembered that the relative size of the territories could be different in the two species.…”

“…The target for DBS in Parkinson's disease has been moved from the thalamus to the globus pallidus and the subthalamic nucleus (STN) (Limousin et al, 1995). This structure, in addition to its role in motor control, has been shown to be involved in the development of non motor diseases such as obsessive compulsive disorders (Mallet et al, 2002). In these pathologies, it is believed that a non motor portion of the STN may receive associative and limbic information from the associative and limbic portions of the external globus pallidus.…”

Deep Brain Stimulation for Psychiatric Disorders

“…In the 2002 series from Paris, two patients were found to have a striking reduction in their Y-BOCS scores (81% and 83%) after unblinded stimulation (Table 2). 35 The authors noted that the active contacts resulting in this clinical effect were more medial than expected in the STN. Although the effect may be the result of stimulation of adjacent structures, they theorized that the changes seen were mediated by the STN itself.…”

“…Finally, subthalamic nucleus (STN) stimulation in Parkinson's patients with co-existent OCD has been implicated as a potential target, and ventral caudate nucleus DBS in one patient showed improvement in both OCD and comorbid major depression. [33][34][35] A group from Belgium reported their results on the use of DBS in the anterior limb of the internal capsule (AIC). 6,36 In their 2003 publication, six patients were implanted with widely spaced electrodes (one with Medtronic Model 3487A Pisces leads, five with Model 3887 Pisces leads) such that the middle two contacts were in the region that would normally be targeted for an anterior capsulotomy.…”