scholarly journals The Subthalamic Nucleus: Unravelling New Roles and Mechanisms in the Control of Action

2018 ◽  
Vol 25 (1) ◽  
pp. 48-64 ◽  
Author(s):  
Tora Bonnevie ◽  
Kareem A. Zaghloul
Keyword(s):  
Deep Brain Stimulation ◽  
Basal Ganglia ◽  
Subthalamic Nucleus ◽  
Action Control ◽  
Brain Disorders ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
High Level ◽  
Deep Brain

How do we decide what we do? This is the essence of action control, the process of selecting the most appropriate response among multiple possible choices. Suboptimal action control can involve a failure to initiate or adapt actions, or conversely it can involve making actions impulsively. There has been an increasing focus on the specific role of the subthalamic nucleus (STN) in action control. This has been fueled by the clinical relevance of this basal ganglia nucleus as a target for deep brain stimulation (DBS), primarily in Parkinson’s disease but also in obsessive-compulsive disorder. The context of DBS has opened windows to study STN function in ways that link neuroscientific and clinical fields closely together, contributing to an exceptionally high level of two-way translation. In this review, we first outline the role of the STN in both motor and nonmotor action control, and then discuss how these functions might be implemented by neuronal activity in the STN. Gaining a better understanding of these topics will not only provide important insights into the neurophysiology of action control but also the pathophysiological mechanisms relevant for several brain disorders and their therapies.

scholarly journals The medial forebrain bundle as a target for deep brain stimulation for obsessive-compulsive disorder

CNS Spectrums ◽  
2016 ◽  
Vol 22 (3) ◽  
pp. 282-289 ◽  
Author(s):  
Volker A. Coenen ◽  
Thomas E. Schlaepfer ◽  
Peter Goll ◽  
Peter C. Reinacher ◽  
Ulrich Voderholzer ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Major Depression ◽  
Brain Stimulation ◽  
Medial Forebrain Bundle ◽  
Reward System ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Deep Brain

Deep brain stimulation (DBS) is a promising putative modality for the treatment of refractory psychiatric disorders such as major depression and obsessive-compulsive disorder (OCD). Several targets have been posited; however, a clear consensus on differential efficacy and possible modes of action remain unclear. DBS to the supero-lateral branch of the medial forebrain bundle (slMFB) has recently been introduced for major depression (MD). Due to our experience with slMFB stimulation for MD, and because OCD might be related to similar dysfunctions of the reward system, treatment with slMFB DBS seams meaningful. Here we describe our first 2 cases together with a hypothetical mode of action.We describe diffusion tensor imaging (DTI) fiber tractographically (FT)-assisted implantation of the bilateral DBS systems in 2 male patients. In a selected literature overview, we discuss the possible mode of action. Both patients were successfully implanted and stimulated. The follow-up time was 12 months. One patient showed a significant response (Yale–Brown Obsessive-Compulsive Scale [YBOCS] reduction by 35%); the other patient reached remission criteria 3 months after surgery (YBOCS<14) and showed mild OCD just above the remission criterion at 12 months follow-up.While the hypermetabolism theory for OCD involves the cortico–striato–thalamo–cortical (CSTC) network, we think that there is clinical evidence that the reward system plays a crucial role. Our findings suggest an important role of this network in mechanisms of disease development and recovery. In this uncontrolled case series, continuous bilateral DBS to the slMFB led to clinically significant improvements of ratings of OCD severity. Ongoing research focuses on the role of the reward system in OCD, and its yet-underestimated role in this underlying neurobiology of the disease.

scholarly journals Deep brain stimulation of the subthalamic nucleus in obsessive–compulsives disorders: long-term follow-up of an open, prospective, observational cohort

2020 ◽  
Vol 91 (12) ◽  
pp. 1349-1356
Author(s):  
Stephan Chabardes ◽  
Paul Krack ◽  
Brigitte Piallat ◽  
Thierry Bougerol ◽  
Eric Seigneuret ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Safe Procedure ◽  
Obsessive Compulsive ◽  
Open Label ◽  
Compulsive Disorder ◽  
The Impact ◽  
Deep Brain

BackgroundObsessive–compulsive disorder (OCD) is a major cause of disability in western country and responsible for severe impairment of quality of life. About 10% of patients present with severe OCD symptoms and require innovative treatment such as deep brain stimulation (DBS). Among possible targets, the non-motor subthalamic nucleus (STN) is a key node of the basal ganglia circuitry, strongly connected to limbic cortical areas known to be involved in OCD.MethodWe analysed, in a prospective, observational, monocentric, open label cohort, the effect of chronic non-motor STN-DBS in 19 patients with treatment-resistant OCD consecutively operated in a single centre. Severity of OCD was evaluated using the Yale and Brown Obsessive–Compulsive Scale (YBOCS). YBOCS scores at 6, 12 and 24 months postoperatively were compared with baseline. Responders were defined by >35% improvement of YBOCS scores. Global Assessment Functioning (GAF) scale was used to evaluate the impact of improvement.ResultsAt a 24-month follow-up, the mean YBOCS score improved by 53.4% from 33.3±3.5 to 15.8±9.1 (95% CI 11.2–20.4; p<0.0001). Fourteen out of 19 patients were considered as responders, 5 out of 19 being improved over 75% and 10 out of 19 over 50%. GAF scale improved by 92% from 34.1±3.9 to 66.4±18.8 (95% CI 56.7–76.1; p=0.0003). The most frequent adverse events consisted of transient DBS-induced hypomania and anxiety.ConclusionChronic DBS of the non-motor STN is an effective and relatively safe procedure to treat severe OCD resistant to conventional management.

Deep Brain Stimulation for Obsessive-Compulsive Disorder Affects Language

Neurosurgery ◽  
2013 ◽  
Vol 73 (5) ◽  
pp. E907-E910 ◽  
Author(s):  
A. Rosaura Polak ◽  
Anke B. Witteveen ◽  
Mariska Mantione ◽  
Martijn Figee ◽  
Pelle de Koning ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Nucleus Accumbens ◽  
Obsessive Compulsive Disorder ◽  
Brain Stimulation ◽  
Clinical Presentation ◽  
Symptom Improvement ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Deep Brain

Abstract BACKGROUND AND IMPORTANCE: Deep brain stimulation (DBS) is an effective treatment for patients with refractory neuropsychiatric disorders. Along with symptom improvement, DBS may have concurrent behavioral effects that help to unravel the role of specific brain circuitries in complex human behavior. CLINICAL PRESENTATION: This article reports on 2 patients with obsessive-compulsive disorder who received DBS targeted at the nucleus accumbens that resulted in a temporary change of accent and use of vocabulary. CONCLUSION: Changes in accent and speaking manners are most likely related to direct DBS stimulation effects of the electrode targeted at the nucleus accumbens. The shift in accent, resembling foreign accent syndrome after injuries in brain language centers, has not been reported before in the course of DBS. Induction of aggressive vocabulary may be related to transient hypomanic behavior after DBS.

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