How Deep Brain Stimulation of the Nucleus Accumbens Affects the Cingulate Gyrus and Vice Versa

The nucleus accumbens (NA) and the cingulate gyrus (CG) are two vital limbic brain structures. They have attracted attention as deep brain stimulation (DBS) targets in the treatment of common refractory psychiatric illness. The primary purpose of this article was to review the current knowledge regarding the way that NA DBS affects the CG and vice versa. Methodologically, a thorough literature review was performed. According to the current literature, NA DBS modulates the function of several brain areas including the CG cortex. It specifically causes activation in the ipsilateral CG cortex and voltage-dependent reduction of its blood oxygenation. It also reverses anterior mid-CG cortex dysfunction and decreases metabolism in the subgenual CG. Moreover, NA DBS that induces mirth inhibits the function of the anterior CG cortex and enhances effective connectivity from anterior CG to the ventral striatum. On the other hand, although it is highly probable that CG DBS affects the NA, the exact nature of its effects remains unclear. Despite the increasing interest in psychiatric DBS, the available data on how NA DBS affects the CG and vice versa are restricted. This conclusion probably reflects the high complexity of the limbic circuits and necessitates further research.

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High-fidelity transmission of high-frequency burst stimuli from peripheral nerve to thalamic nuclei in children with dystonia

Scientific Reports ◽

10.1038/s41598-021-88114-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Estefanía Hernandez-Martin ◽

Enrique Arguelles ◽

Yifei Zheng ◽

Ruta Deshpande ◽

Terence D. Sanger

Keyword(s):

Deep Brain Stimulation ◽

Peripheral Nerve ◽

Brain Stimulation ◽

High Frequency ◽

Sensory Information ◽

Brain Structures ◽

High Fidelity ◽

Thalamic Nuclei ◽

Frequency Burst ◽

Deep Brain

AbstractHigh-frequency peripheral nerve stimulation has emerged as a noninvasive alternative to thalamic deep brain stimulation for some patients with essential tremor. It is not known whether such techniques might be effective for movement disorders in children, nor is the mechanism and transmission of the peripheral stimuli to central brain structures understood. This study was designed to investigate the fidelity of transmission from peripheral nerves to thalamic nuclei in children with dystonia undergoing deep brain stimulation surgery. The ventralis intermediate (VIM) thalamus nuclei showed a robust evoked response to peripheral high-frequency burst stimulation, with a greatest response magnitude to intra-burst frequencies between 50 and 100 Hz, and reliable but smaller responses up to 170 Hz. The earliest response occurred at 12–15 ms following stimulation onset, suggesting rapid high-fidelity transmission between peripheral nerve and thalamic nuclei. A high-bandwidth, low-latency transmission path from peripheral nerve to VIM thalamus is consistent with the importance of rapid and accurate sensory information for the control of coordination and movement via the cerebello-thalamo-cortical pathway. Our results suggest the possibility of non-invasive modulation of thalamic activity in children with dystonia, and therefore the possibility that a subset of children could have beneficial clinical response without the need for invasive deep brain stimulation.

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Performance monitoring in obsessive-compulsive disorder: insights from internal capsule/nucleus accumbens deep brain stimulation

NeuroImage Clinical ◽

10.1016/j.nicl.2021.102746 ◽

2021 ◽

pp. 102746

Author(s):

Thomas Schüller ◽

Theo O.J. Gruendler ◽

Ezra E. Smith ◽

Juan Carlos Baldermann ◽

Sina Kohl ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Nucleus Accumbens ◽

Obsessive Compulsive Disorder ◽

Brain Stimulation ◽

Performance Monitoring ◽

Internal Capsule ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Deep Brain

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Medical Students’ Knowledge and Perception of Deep Brain Stimulation

Journal of Medical Education and Curricular Development ◽

10.1177/2382120521989977 ◽

2021 ◽

Vol 8 ◽

pp. 238212052198997

Author(s):

Brian F Saway ◽

Sanaz Monjazeb ◽

Kerilyn Godbe ◽

Tessa Anwyll ◽

Anita Kablinger ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Medical Students ◽

Brain Stimulation ◽

Treatment Modality ◽

Current Knowledge ◽

Clinical Implementation ◽

Self Assessment ◽

Clinical Exposure ◽

Effective Treatment Modality ◽

Deep Brain

Background: Deep brain stimulation (DBS) is a well-established neurosurgical procedure commonly used in movement and psychiatric disorders. Its widespread clinical implementation, however, may not be commensurate with medical education. No current assessment of medical student’s understanding of DBS as a treatment option for indicated conditions is available, potentially threatening the availability of DBS to future patients. The aim of the present study is to explore the current knowledge and attitudes of medical students toward DBS as a treatment modality. Methods: A total of 65 medical students at Virginia Tech Carilion School of Medicine were surveyed regarding their knowledge of DBS. The survey consisted of a 25-item questionnaire including a demographic section and 3 separate inventories designed to assess bias, knowledge, and self-assessment of knowledge specific to DBS therapy. Students in pre-clinical and clinical years were analyzed separately to describe changes in knowledge or attitude associated with clinical exposure to DBS. Comparisons were analyzed using t tests, ANOVA, and Pearson correlations. Results: Of surveyed students, 36% were unsure of the FDA approval status of DBS treatment; 65% of students believed they had not been adequately educated about DBS and its utility; and 10.6% of students believed that DBS is likely associated with severe adverse effects and/or brain damage. The overall baseline attitudes of students toward DBS were positive. There was no observed difference between surveyed pre-clinical and clinical students, highlighting a lack of exposure throughout the clinical years of medical school education. Conclusion: Although DBS is an effective treatment modality for various conditions, current education is non-commensurate with its application, which can negatively impact awareness and understanding for its implications by medical professionals. In order to better serve patients who may benefit from DBS, medical curricula must change to educate future physicians on the benefit of this intervention.

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