Deep brain stimulation of the subthalamic nucleus in obsessive-compulsive disorder: Neuroanatomical and pathophysiological considerations

Mulders, Anne E.P.; Plantinga, Birgit R.; Schruers, Koen; Duits, Annelien; Janssen, Mark; Ackermans, Linda; Leentjens, Albert F.G.; Jahanshahi, Ali; Temel, Yasin

doi:10.1016/j.euroneuro.2016.10.011

Cited by 36 publications

(24 citation statements)

References 82 publications

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“…STN-DBS has been found effective in the treatment of OCD ( Mallet et al, 2002 ; Mallet et al, 2008 ), a patient group that is likewise impaired on the IGT ( Cavedini et al, 2010 ; Starcke et al, 2010 ; Zhang et al, 2015 ), and in which OFC dysfunction has long been documented ( Modell et al, 1989 ; Saxena et al, 1999 ; Evans et al, 2004 ). Although therapeutic benefit may still be attributed to normalized frontal function ( Le Jeune et al, 2010 ), recent work has documented an electrophysiological signature associated with OCD in the ventromedial STN that is associated with OCD symptom severity, as well as clinical benefit post-DBS ( Piallat et al, 2011 ; Welter et al, 2011 ; Mulders et al, 2016 ). Disrupted information processing at the level of the STN, and its normalization, may therefore play a more fundamental role in both the manifestation of OCD and its resolution following STN-DBS ( Mulders et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

“…Although therapeutic benefit may still be attributed to normalized frontal function ( Le Jeune et al, 2010 ), recent work has documented an electrophysiological signature associated with OCD in the ventromedial STN that is associated with OCD symptom severity, as well as clinical benefit post-DBS ( Piallat et al, 2011 ; Welter et al, 2011 ; Mulders et al, 2016 ). Disrupted information processing at the level of the STN, and its normalization, may therefore play a more fundamental role in both the manifestation of OCD and its resolution following STN-DBS ( Mulders et al, 2016 ). Whether a similar aberration in activity likewise characterizes, and even drives, maladaptive risky choice or compulsive gambling behavior remains to be determined.…”

Section: Discussionmentioning

confidence: 99%

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Deep-Brain Stimulation of the Subthalamic Nucleus Selectively Decreases Risky Choice in Risk-Preferring Rats

Adams

Haar

Tremblay

et al. 2017

eNeuro

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Deep brain stimulation of the subthalamic nucleus (STN-DBS) can improve the motor symptoms of Parkinson’s disease (PD) and negate the problematic side effects of dopamine replacement therapy. Although there is concern that STN-DBS may enhance the development of gambling disorder and other impulse control disorders in this patient group, recent data suggest that STN-DBS may actually reduce iatrogenic impulse control disorders, and alleviate obsessive-compulsive disorder (OCD). Here, we sought to determine whether STN-DBS was beneficial or detrimental to performance of the rat gambling task (rGT), a rodent analogue of the Iowa Gambling Task (IGT) used to assess risky decision making clinically. Rats chose between four options associated with different amounts and probabilities of sugar pellet rewards versus timeout punishments. As in the IGT, the optimal approach was to favor options associated with smaller per-trial gains but lower timeout penalties. Once a stable behavioral baseline was established, electrodes were implanted bilaterally into the STN, and the effects of STN-DBS assessed on-task over 10 consecutive sessions using an A-B-A design. STN-DBS did not affect choice in optimal decision makers that correctly favored options associated with smaller per-trial gains but also lower penalties. However, a minority (∼25%) preferred the maladaptive “high-risk, high-reward” options at baseline. STN-DBS significantly and progressively improved choice in these risk-preferring rats. These data support the hypothesis that STN-DBS may be beneficial in ameliorating maladaptive decision making associated with compulsive and addiction disorders.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Deep-Brain Stimulation of the Subthalamic Nucleus Selectively Decreases Risky Choice in Risk-Preferring Rats

Adams

Haar

Tremblay

et al. 2017

eNeuro

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“…DBS of striatal areas, including the ALIC, VC, and NAc, resulted in an approximately 45% decrease in OCD symptoms, as assessed by the Y‐BOCS . Similarly, DBS of the STN reduced OCD symptoms, and has been proposed to normalize connectivity within corticobasal ganglia‐thalamocortical circuits …”

Section: The Role Of the Basal Ganglia In Psychiatric Disordersmentioning

confidence: 99%

Role of basal ganglia neurocircuitry in the pathology of psychiatric disorders

Macpherson

Hikida

2019

Psychiatry Clin Neurosci

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Over the last few decades, advances in human and animal‐based techniques have greatly enhanced our understanding of the neural mechanisms underlying psychiatric disorders. Many of these studies have indicated connectivity between and alterations within basal ganglia structures to be particularly pertinent to the development of symptoms associated with several of these disorders. Here we summarize the connectivity, molecular composition, and function of sites within basal ganglia neurocircuits. Then we review the current literature from both human and animal studies concerning altered basal ganglia function in five common psychiatric disorders: obsessive–compulsive disorder, substance‐related and addiction disorders, major depressive disorder, generalized anxiety disorder, and schizophrenia. Finally, we present a model based upon the findings of these studies that highlights the striatum as a particularly attractive target for restoring normal function to basal ganglia neurocircuits altered within psychiatric disorder patients.

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“…Although understanding of the etiology of OCD is limited, functional and structural brain imaging studies have revealed aberrant cortico-striato-thalamo-cortical (CSTC) circuits in OCD 1 , 2 . The subthalamic nucleus (STN) has a central position within the CSTC circuits and through its sensorimotor, emotional and cognitive areas coordinates decision-making, action-selection and various high-order processes 3 – 6 . STN deep brain stimulation (DBS) has been studied as a treatment for severe resistant OCD patients 6 – 13 .…”

Section: Introductionmentioning

confidence: 99%

“…The subthalamic nucleus (STN) has a central position within the CSTC circuits and through its sensorimotor, emotional and cognitive areas coordinates decision-making, action-selection and various high-order processes 3 – 6 . STN deep brain stimulation (DBS) has been studied as a treatment for severe resistant OCD patients 6 – 13 . DBS surgery allows both acute and chronic electrophysiological recordings from DBS targets.…”

Section: Introductionmentioning

confidence: 99%

Subthalamic theta activity: a novel human subcortical biomarker for obsessive compulsive disorder

et al. 2018

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Obsessive-compulsive disorder (OCD) is a common and serious psychiatric disorder. Although subthalamic nucleus deep brain stimulation (DBS) has been studied as a treatment for OCD patients the underlying mechanism of this treatment and the optimal method of stimulation are unknown. To study the neural basis of subthalamic nucleus DBS in OCD patients we used a novel, implantable DBS system with long-term local field potential sensing capability. We focus our analysis on two patients with OCD who experienced severe treatment-resistant symptoms and were implanted with subthalamic nucleus DBS systems. We studied them for a year at rest and during provocation of OCD symptoms (46 recording sessions) and compared them to four Parkinson’s disease (PD) patients implanted with subthalamic nucleus DBS systems (69 recording sessions). We show that the dorsal (motor) area of the subthalamic nucleus in OCD patients displays a beta (25–35 Hz) oscillatory activity similar to PD patients whereas the ventral (limbic-cognitive) area of the subthalamic nucleus displays distinct theta (6.5–8 Hz) oscillatory activity only in OCD patients. The subthalamic nucleus theta oscillatory activity decreases with provocation of OCD symptoms and is inversely correlated with symptoms severity over time. We conclude that beta oscillations at the dorsal subthalamic nucleus in OCD patients challenge their pathophysiologic association with movement disorders. Furthermore, theta oscillations at the ventral subthalamic nucleus in OCD patients suggest a new physiological target for OCD therapy as well as a promising input signal for future emotional-cognitive closed-loop DBS.

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Deep brain stimulation of the subthalamic nucleus in obsessive-compulsive disorder: Neuroanatomical and pathophysiological considerations

Cited by 36 publications

References 82 publications

Deep-Brain Stimulation of the Subthalamic Nucleus Selectively Decreases Risky Choice in Risk-Preferring Rats

Deep-Brain Stimulation of the Subthalamic Nucleus Selectively Decreases Risky Choice in Risk-Preferring Rats

Role of basal ganglia neurocircuitry in the pathology of psychiatric disorders

Subthalamic theta activity: a novel human subcortical biomarker for obsessive compulsive disorder

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