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Acute deep brain stimulation changes in regional cerebral blood flow in obsessive-compulsive disorder.
J Neurosurg. 2016 11; 125(5):1087-1093.JN

Abstract

OBJECTIVE

Deep brain stimulation (DBS) is a reversible, nonlesion-based treatment for patients with intractable obsessive-compulsive disorder (OCD). The first studies on DBS for OCD stimulating the ventral capsule/ventral striatum (VC/VS) yielded encouraging results for this neuroanatomical site's therapeutic efficacy. This investigation was conducted to better understand which regions of the cortico-striatal-thalamic-cortical network were acutely affected by VC/VS DBS for OCD. Furthermore, the objective was to identify which brain regions demonstrated changes in perfusion, as stimulation was applied across a dorsoventral lead axis that corresponded to different anatomical locations in the VC/VS.

METHODS

Six patients receiving VC/VS DBS for OCD underwent oxygen-15 positron emission tomography (15O-PET) scanning. Monopolar DBS was delivered at each of the 4 different electrodes on the stimulating lead in the VC/VS. The data were analyzed using SPM5. Paired t-tests were run in SPSS to identify significant changes in regional cerebral blood flow (rCBF) between stimulation conditions. Pearson's r correlations were run between these significant changes in rCBF and changes in OCD and depressive symptom severity.

RESULTS

Perfusion in the dorsal anterior cingulate cortex (dACC) significantly increased when monopolar DBS was turned on at the most ventral DBS contact, and this increase in dACC activity was correlated with reductions in depressive symptom severity (r(5) = -0.994, p = 0.001). Perfusion in the thalamus, striatum, and globus pallidus significantly increased when DBS was turned on at the most dorsal contact.

CONCLUSIONS

DBS of the VC/VS appears to modulate activity in the regions implicated in the pathophysiology of OCD. Different regions in the cortico-striatal-thalamic-cortical circuit showed increased perfusion based on whether the stimulation was more ventral or dorsal along the lead axis in the VC/VS. Evidence was found that DBS at the most ventral site was associated with clinical changes in depressive symptom severity, but not OCD symptom severity.

Authors+Show Affiliations

Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown.Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown. Department of Psychology, Harvard University, Cambridge.Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown.Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown.Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown. Picower Institute for Learning & Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts.Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown.Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown.Department of Psychiatry and Behavioral Sciences, Butler Hospital and Brown Medical School, Providence, Rhode Island; and.Department of Pharmacology and Physiology, University of Rochester Medical Center, Rochester, New York.Division of Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

26894459

Citation

Dougherty, Darin D., et al. "Acute Deep Brain Stimulation Changes in Regional Cerebral Blood Flow in Obsessive-compulsive Disorder." Journal of Neurosurgery, vol. 125, no. 5, 2016, pp. 1087-1093.
Dougherty DD, Chou T, Corse AK, et al. Acute deep brain stimulation changes in regional cerebral blood flow in obsessive-compulsive disorder. J Neurosurg. 2016;125(5):1087-1093.
Dougherty, D. D., Chou, T., Corse, A. K., Arulpragasam, A. R., Widge, A. S., Cusin, C., Evans, K. C., Greenberg, B. D., Haber, S. N., & Deckersbach, T. (2016). Acute deep brain stimulation changes in regional cerebral blood flow in obsessive-compulsive disorder. Journal of Neurosurgery, 125(5), 1087-1093.
Dougherty DD, et al. Acute Deep Brain Stimulation Changes in Regional Cerebral Blood Flow in Obsessive-compulsive Disorder. J Neurosurg. 2016;125(5):1087-1093. PubMed PMID: 26894459.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute deep brain stimulation changes in regional cerebral blood flow in obsessive-compulsive disorder. AU - Dougherty,Darin D, AU - Chou,Tina, AU - Corse,Andrew K, AU - Arulpragasam,Amanda R, AU - Widge,Alik S, AU - Cusin,Cristina, AU - Evans,Karleyton C, AU - Greenberg,Benjamin D, AU - Haber,Suzanne N, AU - Deckersbach,Thilo, Y1 - 2016/02/19/ PY - 2016/11/2/pubmed PY - 2018/8/3/medline PY - 2016/2/20/entrez KW - 15O-PET = oxygen-15 positron emission tomography KW - ACC = anterior cingulate cortex KW - DBS = deep brain stimulation KW - FDG = fluorodeoxyglucose KW - FWHM = full width at half maximum KW - HAM-D = Hamilton Depression Rating Scale KW - MGH = Massachusetts General Hospital KW - MNI = Montreal Neurological Institute KW - OCD = obsessive-compulsive disorder KW - OFC = orbitofrontal cortex KW - ROI = region of interest KW - VC/VS = ventral capsule/ventral striatum KW - Y-BOCS = Yale-Brown Obsessive Compulsive Scale KW - cortico-striatal-thalamic-cortical circuit KW - dACC = dorsal anterior cingulate cortex KW - deep brain stimulation KW - functional neurosurgery KW - obsessive-compulsive disorder KW - positron emission tomography KW - rCBF = regional cerebral blood flow KW - ventral capsule/ventral striatum KW - vmPFC = ventromedial prefrontal cortex SP - 1087 EP - 1093 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 125 IS - 5 N2 - OBJECTIVE Deep brain stimulation (DBS) is a reversible, nonlesion-based treatment for patients with intractable obsessive-compulsive disorder (OCD). The first studies on DBS for OCD stimulating the ventral capsule/ventral striatum (VC/VS) yielded encouraging results for this neuroanatomical site's therapeutic efficacy. This investigation was conducted to better understand which regions of the cortico-striatal-thalamic-cortical network were acutely affected by VC/VS DBS for OCD. Furthermore, the objective was to identify which brain regions demonstrated changes in perfusion, as stimulation was applied across a dorsoventral lead axis that corresponded to different anatomical locations in the VC/VS. METHODS Six patients receiving VC/VS DBS for OCD underwent oxygen-15 positron emission tomography (15O-PET) scanning. Monopolar DBS was delivered at each of the 4 different electrodes on the stimulating lead in the VC/VS. The data were analyzed using SPM5. Paired t-tests were run in SPSS to identify significant changes in regional cerebral blood flow (rCBF) between stimulation conditions. Pearson's r correlations were run between these significant changes in rCBF and changes in OCD and depressive symptom severity. RESULTS Perfusion in the dorsal anterior cingulate cortex (dACC) significantly increased when monopolar DBS was turned on at the most ventral DBS contact, and this increase in dACC activity was correlated with reductions in depressive symptom severity (r(5) = -0.994, p = 0.001). Perfusion in the thalamus, striatum, and globus pallidus significantly increased when DBS was turned on at the most dorsal contact. CONCLUSIONS DBS of the VC/VS appears to modulate activity in the regions implicated in the pathophysiology of OCD. Different regions in the cortico-striatal-thalamic-cortical circuit showed increased perfusion based on whether the stimulation was more ventral or dorsal along the lead axis in the VC/VS. Evidence was found that DBS at the most ventral site was associated with clinical changes in depressive symptom severity, but not OCD symptom severity. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/26894459/Acute_deep_brain_stimulation_changes_in_regional_cerebral_blood_flow_in_obsessive_compulsive_disorder_ L2 - https://thejns.org/doi/10.3171/2015.9.JNS151387 DB - PRIME DP - Unbound Medicine ER -