scholarly journals Chronic deep brain stimulation of the human nucleus accumbens region disrupts the stability of inter-temporal preferences

2020 ◽  
Author(s):  
Ben J. Wagner ◽  
Canan B. Schüller ◽  
Thomas Schüller ◽  
Juan C. Baldermann ◽  
Sina Kohl ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Nucleus Accumbens ◽  
Brain Stimulation ◽  
Internal Capsule ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Preference Stability ◽  
The Stability ◽  
Deep Brain ◽  
Temporal Preferences

AbstractWhen choosing between rewards that differ in temporal proximity (inter-temporal choice), human preferences are typically stable, constituting a clinically-relevant transdiagnostic trait. Here we show in patients undergoing deep brain stimulation (DBS) to the anterior limb of the internal capsule / nucleus accumbens for treatment-resistant obsessive-compulsive disorder, that chronic (but not acute) DBS disrupts inter-temporal preferences. Findings support a contribution of the human nucleus accumbens region to preference stability over time.

Open-label trial of anterior limb of internal capsule–nucleus accumbens deep brain stimulation for obsessive-compulsive disorder: insights gained

2019 ◽  
Vol 90 (7) ◽  
pp. 805-812 ◽  
Author(s):  
Daniel Huys ◽  
Sina Kohl ◽  
Juan Carlos Baldermann ◽  
Lars Timmermann ◽  
Volker Sturm ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Nucleus Accumbens ◽  
Executive Functions ◽  
Obsessive Compulsive Disorder ◽  
Brain Stimulation ◽  
Internal Capsule ◽  
Obsessive Compulsive ◽  
Open Label ◽  
Compulsive Disorder ◽  
Deep Brain

BackgroundFor more than 15 years, deep brain stimulation (DBS) has served as a last-resort treatment for severe treatment-resistant obsessive-compulsive disorder (OCD).MethodsFrom 2010 to 2016, 20 patients with OCD (10 men/10 women) were included in a single-centre trial with a naturalistic open-label design over 1 year to evaluate the effects of DBS in the anterior limb of the internal capsule and nucleus accumbens region (ALIC-NAcc) on OCD symptoms, executive functions, and personality traits.ResultsALIC-NAcc-DBS significantly decreased OCD symptoms (mean Yale-Brown Obsessive Compulsive Scale reduction 33%, 40% full responders) and improves global functioning without loss of efficacy over 1 year. No significant changes were found in depressive or anxiety symptoms. Our study did not show any effect of ALIC-NAcc-DBS on personality traits or executive functions, and no potential outcome predictors were identified in a post hoc analysis. Other than several individual minor adverse events, ALIC-NAcc-DBS has been shown to be safe, but 35% of patients reported a sudden increase in anxiety and anhedonia after acute cessation of stimulation.ConclusionsWe conclude that ALIC-NAcc-DBS is a well-tolerated and promising last-resort treatment option for OCD. The cause of variability in the outcome remains unclear, and the aspect of reversibility must be examined critically. The present data from one of the largest samples of patients with OCD treated with DBS thus far support the results of previous studies with smaller samples.

scholarly journals Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

2019 ◽  
Author(s):  
Ningfei Li ◽  
Juan Carlos Baldermann ◽  
Astrid Kibleur ◽  
Svenja Treu ◽  
Harith Akram ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Improvement ◽  
Obsessive Compulsive Disorder ◽  
Brain Stimulation ◽  
Internal Capsule ◽  
Anterior Cingulate ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Fiber Tracts ◽  
Deep Brain

AbstractMultiple surgical targets have been proposed for treating obsessive-compulsive disorder (OCD) with deep brain stimulation (DBS). However, different targets may modulate the same neural network responsible for clinical improvement. Here we analyzed data from four cohorts of OCD patients (N = 50) that underwent DBS to the anterior limb of the internal capsule (ALIC), the nucleus accumbens (NAcc) or the subthalamic nucleus (STN). Fiber tracts that were predominantly connected to electrodes in good or poor DBS responders were isolated from a normative structural connectome and assigned a predictive value. Strikingly, the same fiber bundle was related to treatment response when independently analyzing two large training cohorts that targeted either ALIC or STN. This discriminative tract is a subsection of the ALIC and connects frontal regions (such as the dorsal anterior cingulate, dACC, and ventral prefrontal, vlPFC, cortices to the STN). When informing the tract solely based on one cohort (e.g. ALIC), clinical improvements in the other (e.g. STN) could be significantly predicted, and vice versa. Finally, clinical improvements of eight patients from a third center with electrodes in the NAcc and six patients from a fourth center in which electrodes had been implanted in both STN and ALIC were significantly predicted based on this novel tract-based DBS target. Results suggest a functional role of a limbic hyperdirect pathway that projects from dACC and vlPFC to anteriomedial STN. Obsessive-compulsive symptoms seem to be tractable by modulating the specific bundle isolated here. Our results show that connectivity-derived improvement models can inform clinical improvement across DBS targets, surgeons and centers. The identified tract is now three-dimensionally defined in stereotactic standard space and will be made openly available.

scholarly journals Deep Brain Stimulation of the Nucleus Accumbens for Treatment-Refractory Obsessive-Compulsive Disorder

2010 ◽  
Vol 67 (10) ◽  
pp. 1061 ◽  
Author(s):  
Damiaan Denys ◽  
Mariska Mantione ◽  
Martijn Figee ◽  
Pepijn van den Munckhof ◽  
Frank Koerselman ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Nucleus Accumbens ◽  
Obsessive Compulsive Disorder ◽  
Brain Stimulation ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Treatment Refractory ◽  
Deep Brain ◽  
Stimulation Of
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