scholarly journals Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review

2021 ◽  
Vol 11 (7) ◽  
pp. 948
Author(s):  
Nicola Acevedo ◽  
Peter Bosanac ◽  
Toni Pikoos ◽  
Susan Rossell ◽  
David Castle
Keyword(s):  
Clinical Characteristics ◽  
Target Selection ◽  
Response Analysis ◽  
Sweet Spot ◽  
Treatment Optimization ◽  
Obsessive Compulsive ◽  
Narrow Scope ◽  
Stimulation Parameters ◽  
Multiple Structures ◽  
Deep Brain

Invasive and noninvasive neurostimulation therapies for obsessive-compulsive and related disorders (OCRD) were systematically reviewed with the aim of assessing clinical characteristics, methodologies, neuroanatomical substrates, and varied stimulation parameters. Previous reviews have focused on a narrow scope, statistical rather than clinical significance, grouped together heterogenous protocols, and proposed inconclusive outcomes and directions. Herein, a comprehensive and transdiagnostic evaluation of all clinically relevant determinants is presented with translational clinical recommendations and novel response rates. Electroconvulsive therapy (ECT) studies were limited in number and quality but demonstrated greater efficacy than previously identified. Targeting the pre-SMA/SMA is recommended for transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). TMS yielded superior outcomes, although polarity findings were conflicting, and refinement of frontal/cognitive control protocols may optimize outcomes. For both techniques, standardization of polarity, more treatment sessions (>20), and targeting multiple structures are encouraged. A deep brain stimulation (DBS) ‘sweet spot’ of the striatum for OCD was proposed, and CBT is strongly encouraged. Tourette’s patients showed less variance and reliance on treatment optimization. Several DBS targets achieved consistent, rapid, and sustained clinical response. Analysis of fiber connectivity, as opposed to precise neural regions, should be implemented for target selection. Standardization of protocols is necessary to achieve translational outcomes.

Use of Subthalamic Nucleus and Globus Pallidus Interna Deep Brain Stimulation Targets in the Same Patient With Parkinson’s Disease

2020 ◽  
pp. 69-72
Author(s):  
Shabbir Hussain I. Merchant ◽  
Nora Vanegas-Arroyave
Keyword(s):  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Clinical Characteristics ◽  
Target Selection ◽  
Contralateral Side ◽  
Clinical Severity ◽  
Clinical Characteristic ◽  
Deep Brain

Deep brain stimulation (DBS) is an excellent therapy for the treatment of levodopa-refractory tremor and motor fluctuations in Parkinson disease (PD). Asymmetry is an inherent clinical characteristic of PD, noted in terms of clinical severity, but can also be noted in terms of the clinical characteristics of PD motor symptoms. This chapter presents a case of a patient with relatively early onset of PD, whose phenotype was characterized by predominant medication-refractory tremor on one side and hemidystonia on the contralateral side. He was successfully treated using DBS, with a combination of subthalamic nucleus (contralateral to the tremor predominant side) and globus pallidus interna (contralateral to the dystonia predominant side) targets to facilitate medication reduction, tremor resolution, and treatment of dystonia and dystonic dyskinesias. The case highlights the importance of using a nuanced approach in DBS target selection in PD, based on the phenomenologic characteristics and consideration of postoperative programming challenges for optimal treatment outcomes.

scholarly journals Distribution of electric field in patients with obsessive compulsive disorder treated with deep brain stimulation of the bed nucleus of stria terminalis

2021 ◽  
Author(s):  
Matilda Naesström ◽  
Johannes Johansson ◽  
Marwan Hariz ◽  
Owe Bodlund ◽  
Karin Wårdell ◽  
...  
Keyword(s):  
Electric Field ◽  
Internal Capsule ◽  
Stria Terminalis ◽  
Obsessive Compulsive ◽  
Bed Nucleus ◽  
Compulsive Disorder ◽  
Stimulation Parameters ◽  
Deep Brain ◽  
Stimulation Of

Abstract Background Deep brain stimulation (DBS) is being investigated as a treatment for therapy-refractory obsessive compulsive disorder (OCD). Many different brain targets are being trialled. Several of these targets such as the ventral striatum (including the nucleus accumbens (NAc)), the ventral capsule, the inferior thalamic peduncle, and the bed nucleus of stria terminalis (BNST)) belong to the same network, are anatomically very close to one another, or even overlap. Data is still missing on how various stimulation parameters in a given target will affect surrounding anatomical areas and impact the clinical outcome of DBS. Methods In a pilot study of eleven participants with DBS of the BNST, we investigate through patient-specific simulation of electric field, which anatomical areas are affected by the electric field, and if this can be related to the clinical results. Our study combined individual patient’s stimulation parameters at 12- and 24-month follow-up with image data from the preoperative MRI and postoperative CT. These data were used to calculate the distribution of electric field and create individual anatomical models of the field of stimulation. Results The individual electric stimulation fields by stimulation in the BNST were similar at both the 12- and 24-month follow-up, involving mainly anterior limb of the internal capsule (ALIC), genu of the internal capsule (IC), BNST, fornix, anteromedial globus pallidus externa (GPe), and the anterior commissure. A statistical significant correlation (p < 0.05) between clinical effect measured by the Yale-Brown Obsessive Compulsive Scale and stimulation was found at the 12-month follow-up in the ventral ALIC and anteromedial GPe. Conclusions Many of the targets under investigation for OCD are in anatomical proximity. As seen in our study, off-target effects are overlapping. Therefore, DBS in the region of ALIC, NAc, and BNST may perhaps be considered to be stimulation of the same target.

scholarly journals Conceptual Design of Flex-DBS, a Mechanically Reconfigurable Deep Brain Stimulation Probe

2017 ◽  
Author(s):  
Gregory Johnson ◽  
Lauri Lehto ◽  
Silvia Mangia ◽  
Olli Gröhn ◽  
Shalom Michaeli ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Target Selection ◽  
Three Dimensional ◽  
Orientation Tuning ◽  
Current Steering ◽  
Obsessive Compulsive ◽  
Field Orientation ◽  
Compulsive Disorder ◽  
Deep Brain

Deep Brain Stimulation (DBS) has demonstrated outstanding results for the treatment of medically intractable Parkinson’s disease (PD), essential tremor and other neurological and psychiatric disorders, such as Obsessive Compulsive Disorder (OCD) and major depression [1,2]. Despite widespread proliferation, efficacy of DBS treatment is limited primarily because of two key limitations as shown in Fig. 1: (a) non-specific activation of regions implicated in DBS side effects, and (b) inefficient neurostimulation due to complex anatomical structure and axonal orientations of target regions. Thus, there is a need to develop approaches to DBS that achieve more precise target selection and efficient activation of axonal pathways within the brain. Recent efforts in target selection has focused on shaping the stimulation field by using multichannel electrodes for current steering [3]. These multichannel electrodes are limited to cylindrical lead configuration and can only correct for small spatial localization errors, and they do not utilize the direction of the electrical field’s gradients to stimulate neurons depending on their orientation (mainly orientation of axons). Thus, there is a critical need for new electrode architectures that enable both spatial steering and stimulation field orientation tuning capabilities. Here we present the Flex-DBS, a novel DBS electrode lead architecture that harnesses recent advances in flexible probe fabrication and precision guidance strategy to mechanically reconfigure electrodes in three dimensional orientations within anatomically complex brain tissue. Further, it incorporates dense arrays of electrodes with each lead that allow stimulation field orientation tuning.

Treatment of patients with intractable obsessive—compulsive disorder with anterior capsular stimulation

2003 ◽  
Vol 98 (5) ◽  
pp. 1104-1108 ◽  
Author(s):  
Douglas Anderson ◽  
Azam Ahmed
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Therapeutic Benefit ◽  
Obsessive Compulsive ◽  
Content Type ◽  
Compulsive Disorder ◽  
Stimulation Parameters ◽  
Patient Responses ◽  
Postoperative Administration ◽  
Fine Print ◽  
Deep Brain

✓ Obsessive—compulsive disorder (OCD) is a common, chronic, disabling anxiety disorder characterized by recurrent obsessive thoughts and uncontrolled repetitive acts. Although many patients respond to various pharmacological treatments, there is a cohort of patients with intractable or refractory disease. The authors present the case of a patient with intractable OCD who was treated with bilateral electrical stimulators, which were stereotactically placed in the anterior limbs of the internal capsules. Following psychiatric consultation and 10 years of empirical medication regimens for OCD, a woman was referred for neurosurgical evaluation. After informed consent had been obtained from the patient, the authors placed bilateral stimulator leads in the anterior limbs of the internal capsules. The stereotactic coordinates were based on data in pertinent current literature. The stimulation parameters, which are presented in this paper, were set at 2 weeks and reviewed at 6 weeks and 3 months postoperatively. No changes were required. Postoperative analysis included evaluation by the patient's referring psychiatrist, a second independent psychiatrist, and pre- and postoperative administration of the Yale—Brown Obsessive Compulsive Scale. A marked improvement was noted in this patient's OCD symptomatology and general psychosocial function. Previous documentation of patient responses to psychosurgical procedures for intractable or refractory OCD has been met with little enthusiasm, presumably because of the invasiveness and irreversibility of the surgery. In this report the authors suggest that deep brain stimulation of appropriate targets may be an effective and safe treatment for certain patients with OCD and a potentially reversible treatment for those patients who do not obtain therapeutic benefit.

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