Deep brain stimulation: from neurology to psychiatry?

Abstract

International audienceFunctional stereotaxy was introduced in the late 1940s to reduce the morbidity of lobotomy in psychiatric disease by using more focal lesions. The advent of neuroleptics led to a drastic decline in psychosurgery for several decades. Functional stereotactic neurosurgery has recently been revitalized, starting with treatment of Parkinson's disease, in which deep brain stimulation (DBS) facilitates reversible focal neuromodulation of altered basal ganglia circuits. DBS is now being extended to treatment of neuropsychiatric conditions such as Gilles de la Tourette syndrome, obsessive-compulsive disorder, depression and addiction. In this review, we discuss the concept that dysfunction of motor, limbic and associative cortico-basal ganglia-thalamocortical loops underlies these various disorders, which might now be amenable to DBS treatment

Deep Brain Stimulation for Obsessive-Compulsive Disorder: Subthalamic Nucleus Target

“…These clinical observations have been carefully reported and have led to the concept that deep nuclei, such as the STN, a target commonly used to treat patients with PD, could induce limbic side effects systematically reproduced when the stimulator was switched ON. These observations paved the way for new exploratory applications of electrical stimulation targeting limbic/cognitive regions to treat nonmotor symptoms that are encountered in psychiatric disorders such as OCD, depression, Gilles de la Tourette syndrome, or addiction (18). This regain of interest in surgery for mood and cognitive disorders brought together anatomic and physiologic knowledge of the neuronal circuitry involved in these psychiatric disorders.…”

“…The noM-STN appears to be a key node between the associative/limbic cortex, the nonmotor subterritories of basal ganglia, and the thalamus. Review of the surgical literature in the field of psychiatry (18) has highlighted that all targets shown to improve symptoms of OCD, depression, Gilles de la Tourette syndrome, or addiction involve the nonmotor (limbic and/or associative) corticobasal ganglia-thalamo-cortical loops described in the Alexander model of basal ganglia circuitry (1) (see Temel et al [32] for review).…”

“…Usually lesions of STN lead to modulation of impulsive choice and action (34,37). Increase of impulsivity has recently been proposed (18) as one of the mechanism of action of STN-DBS in OCD (discussed later).…”

Changes of oscillatory activity in the subthalamic nucleus during obsessive-compulsive disorder symptoms: Two case reports

“…Thus, abnormal low frequency activity in the STN during acute OCD might reflect pathological (repetitive) action selection that is the hallmark of OCD. However, the involvement of both low and high LFP frequencies may highlight a more general dysfunction of the associative-limbic circuitry (Graybiel & Rauch, 2000;Krack, Hariz, Baunez, Guridi, & Obeso, 2010), which translates into an over-stabilization of the stream of behaviour, thoughts and motivations that characterize OCD patients.…”

Psychiatric considerations in deep brain stimulation for Parkinson’s disease

“…Like other major life-changing interventions, the postoperative state is also characterized by significant psychosocial changes including issues such as the patient's expectations for surgery, identity, work, and relationships (Houeto et al, 2006). Stimulation may itself have an effect, with case reports of acute stimulation-induced behaviors of mania, disinhibition, depression, and aggression (Krack et al, 2010;Volkmann et al, 2010). Stimulation of the limbicassociative STN (below, anterior, and medial to the sensorimotor STN, which is the optimal motor target) has been associated with both positive and negative mood symptoms (Funkiewiez et al, 2003;Krack et al, 2010).…”