Obsessive-Compulsive Disorder: Development of Demand-Controlled Deep Brain Stimulation with Methods from Stochastic Phase Resetting

Tass, Peter A.; Klosterkötter, Joachim; Schneider, Frank; Lenartz, Doris; Koulousakis, A.; Sturm, Volker

doi:10.1038/sj.npp.1300144

Cited by 64 publications

(39 citation statements)

References 38 publications

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“…Future refinements may include the development of a demand-controlled rather than an open loop stimulator. 75 This type of device could responsively apply stimulation when necessary, potentially providing greater behavioral control, reducing side effects, and extending battery life. Indeed, our understanding of the underlying mechanisms obtained through experience with DBS may even lead to completely novel and individualized approaches.…”

Section: Discussionmentioning

confidence: 99%

Deep brain stimulation for obsessive-compulsive disorder: past, present, and future

Mian

Campos

Sheth

et al. 2010

FOC

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Obsessive-compulsive disorder (OCD) is a psychiatric illness that can lead to chronic functional impairment. Some patients with severe, chronic OCD have been treated with ablative neurosurgical techniques over the past 4 decades. More recently, deep brain stimulation (DBS) has been investigated as a therapy for refractory OCD, and the procedure was granted a limited humanitarian device exemption by the FDA in 2009. In this article, the authors review the development of DBS for OCD, describe the current understanding of the pathophysiological mechanisms of the disorder and how the underlying neural circuits might be modulated by DBS, and discuss the clinical studies that provide evidence for the use of this evolving therapy. The authors conclude with suggestions for how a combined basic science and translational research approach could drive the understanding of the neural mechanisms underlying OCD as well as the clinical effectiveness of DBS in the setting of recalcitrant disease.

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Section: Discussionmentioning

confidence: 99%

Deep brain stimulation for obsessive-compulsive disorder: past, present, and future

Mian

Campos

Sheth

et al. 2010

FOC

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“…Importantly, this nucleus receives major inputs from the prefrontal cortex and amygdala and dopaminergic innervation from the ventral tegmental area, and it projects to the ventral pallidum as part of the limbic basal ganglion circuit (Kopell and Greenberg 2008). Furthermore, the NAc is situated immediately adjacent to the anterior limb of the internal capsule of the basal ganglia, whose white matter tracts connect limbic and orbitofrontal structures (Tass et al 2003). Thus, in addition to altering local activity, NAc stimulation can modulate the function of a number of distal targets that are implicated in psychiatric disorders.…”

Section: Network Effects Of Nucleus Accumbens Stimulationmentioning

confidence: 99%

Network effects of deep brain stimulation

Alhourani

McDowell

Randazzo

et al. 2015

Journal of Neurophysiology

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The ability to differentially alter specific brain functions via deep brain stimulation (DBS) represents a monumental advance in clinical neuroscience, as well as within medicine as a whole. Despite the efficacy of DBS in the treatment of movement disorders, for which it is often the gold-standard therapy when medical management becomes inadequate, the mechanisms through which DBS in various brain targets produces therapeutic effects is still not well understood. This limited knowledge is a barrier to improving efficacy and reducing side effects in clinical brain stimulation. A field of study related to assessing the network effects of DBS is gradually emerging that promises to reveal aspects of the underlying pathophysiology of various brain disorders and their response to DBS that will be critical to advancing the field. This review summarizes the nascent literature related to network effects of DBS measured by cerebral blood flow and metabolic imaging, functional imaging, and electrophysiology (scalp and intracranial electroencephalography and magnetoencephalography) in order to establish a framework for future studies. deep brain stimulation; electrocorticography; magnetoencephalography DEEP BRAIN STIMULATION (DBS) provides a unique opportunity for further understanding of healthy and aberrant human brain function. DBS is the only paradigm in which specific deep brain regions may be manipulated through focal electrical stimulation while simultaneously recording brain activity. An emerging field of study has begun to elucidate how different DBS targets modulate network activity in connected brain regions.

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“…The most effective monopolar (patients 2-13) and bipolar contacts (patient 1) for chronic DBS established during stimulator programming (table 1) and pulse width of 60 s was used. Because resetting the oscillation of a population of neurons is most effective with a strong pulse, 23 the voltages used for all individualized frequencies were adjusted to the highest amplitudes without any side effects whereas the voltages for the HF were those used for chronic DBS. The order of DBS frequencies tested was randomized for each day of the study.…”

Section: Experiments 2: Testing Individualized Frequencies On Pd Motormentioning

confidence: 99%

Subthalamic deep brain stimulation at individualized frequencies for Parkinson disease

Tsang¹,

Hamani²,

Moro³

et al. 2012

Neurology

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Objectives: The oscillation model of Parkinson disease (PD) states that, in the subthalamic nucleus (STN), increased (4-10 Hz) and ␤ (11-30 Hz) frequencies were associated with worsening whereas ␥ frequencies (31-100 Hz) were associated with improvement of motor symptoms. However, the peak STN frequency in each band varied widely from subject to subject. We hypothesized that STN deep brain stimulation (DBS) at individualized ␥ frequencies would improve whereas or ␤ frequencies would worsen PD motor signs. Methods:We prospectively studied 13 patients with PD. STN local field potential (LFP) was recorded after electrode implantations, in the OFF and then in ON dopaminergic medication states while patients performed wrist movements. Six individual peak frequencies of the STN LFP power spectra were obtained: the greatest decrease in and ␤ and greatest increase in ␥ frequencies in the ON state (MED) and during movements (MOVE). Eight DBS frequencies were applied including 6 MED and MOVE frequencies, high frequency (HF) used for chronic stimulation, and no stimulation. The patients were assessed using the motor Unified Parkinson's Disease Rating Scale (mUPDRS).Results: STN DBS at ␥ frequencies (MED and MOVE) and HF significantly improved mUPDRS scores compared to no stimulation and both ␥ frequencies were not different from HF. DBS at and ␤ frequencies did not worsen mUPDRS scores compared to no stimulation. Conclusion:Short-term administration of STN DBS at peak dopamine-dependent or movementrelated ␥ frequencies were as effective as HF for reducing parkinsonian motor signs but DBS at and ␤ frequencies did not worsen PD motor signs. Classification of evidence:This study provides Class III evidence that STN DBS at patient-specific ␥ frequencies and at usual high frequencies both improved mUPDRS scores compared to no stimulation and did not differ in effect. Neurology 1 Studies of oscillatory activities in the basal ganglia (BG) in patients with PD suggested that parkinsonian motor symptoms may be related to excessive pathologic oscillations in the BG in the low frequencies (Ͻ30 Hz).2,3 Increased (4 -10 Hz) frequencies in STN were associated with parkinsonian resting tremor. 4 Moreover, excessive ␤ (11-30 Hz) frequencies were recorded from the STN when patients with PD were withdrawn from their dopaminergic medications (OFF state) 5-7 and these frequencies were reduced when patients were in the on dopaminergic

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Obsessive-Compulsive Disorder: Development of Demand-Controlled Deep Brain Stimulation with Methods from Stochastic Phase Resetting

Cited by 64 publications

References 38 publications

Deep brain stimulation for obsessive-compulsive disorder: past, present, and future

Deep brain stimulation for obsessive-compulsive disorder: past, present, and future

Network effects of deep brain stimulation

Subthalamic deep brain stimulation at individualized frequencies for Parkinson disease

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