Successful Treatment of Psychiatric Symptoms after Traumatic Brain Injury Using Deep Brain Stimulation to the Anterior Limb of Internal Capsule-Nucleus Accumbens

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.

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Improved Function After Deep Brain Stimulation for Chronic, Severe Traumatic Brain Injury

Neurosurgery ◽

10.1227/neu.0000000000001190 ◽

2016 ◽

Vol 79 (2) ◽

pp. 204-211 ◽

Cited By ~ 20

Author(s):

Ali R. Rezai ◽

Per B. Sederberg ◽

Jennifer Bogner ◽

Dylan M. Nielson ◽

Jun Zhang ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Prefrontal Cortex ◽

Deep Brain Stimulation ◽

Brain Injury ◽

Brain Stimulation ◽

Severe Traumatic Brain Injury ◽

Emotional Adjustment ◽

Functional Independence ◽

Potential Effectiveness ◽

Deep Brain

Abstract BACKGROUND: Severe traumatic brain injury (TBI) damages the frontal lobes and connecting networks, which impairs executive functions, including the ability to self-regulate. Despite significant disabling effects, there are few treatment options in the chronic phase after injury. OBJECTIVE: To investigate the safety and potential effectiveness of deep brain stimulation (DBS) for individuals with chronic, disabling TBI and problems of behavioral and emotional self-regulation. METHODS: This study was an open-label, prospective design with serial assessments of behavioral outcomes and positron emission tomography 2 years after DBS implantation. Four participants 6 to 21 years after severe TBIs from automobile crashes were included. Although alert and volitional, all experienced significant executive impairments, including either impulsivity or reduced initiation. DBS implants were placed bilaterally in the nucleus accumbens and anterior limb of the internal capsule to modulate the prefrontal cortex. RESULTS: The procedure was safe, and all participants had improved functional outcomes. Two years after implantation, 3 met a priori criteria for improvement on the Mayo-Portland Adaptability Inventory-4. Improvement was due largely to better emotional adjustment, although 1 participant showed marked increases in multiple domains. Significant improvement in a composite score of functional capacity indicated improved independence in self-care and activities of daily living. The pattern of change in cognition corresponded with changes in activation of the prefrontal cortex observed in serial scanning. CONCLUSION: This first study of DBS to this target for severe TBI supports its safety and suggests potential effectiveness to improve function years after injury. The primary impact was on behavioral and emotional adjustment, which in turn improved functional independence. Supplemental Digital Content is Available in the Text. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.neurosurgery-online.com).

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Successful Treatment of Chronic Resistant Alcoholism by Deep Brain Stimulation of Nucleus Accumbens: First Experience with Three Cases

Pharmacopsychiatry ◽

10.1055/s-0029-1233489 ◽

2009 ◽

Vol 42 (06) ◽

pp. 288-291 ◽

Cited By ~ 106

Author(s):

U. J. Müller ◽

V. Sturm ◽

J. Voges ◽

H.-J. Heinze ◽

I. Galazky ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Nucleus Accumbens ◽

Successful Treatment ◽

Brain Stimulation ◽

Deep Brain ◽

Stimulation Of

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Anesthesia for deep brain stimulation in traumatic brain injury‐induced hemidystonia

Clinical Case Reports ◽

10.1002/ccr3.289 ◽

2015 ◽

Vol 3 (6) ◽

pp. 492-495 ◽

Cited By ~ 1

Author(s):

Jill M. Jani ◽

Chima O. Oluigbo ◽

Srijaya K. Reddy

Keyword(s):

Traumatic Brain Injury ◽

Deep Brain Stimulation ◽

Brain Injury ◽

Brain Stimulation ◽

Deep Brain

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Deep brain stimulation of the nucleus accumbens and the internal capsule in therapeutically refractory Tourette-syndrome

Journal of Neurology ◽

10.1007/s00415-006-0404-8 ◽

2007 ◽

Vol 254 (7) ◽

pp. 963-965 ◽

Cited By ~ 107

Author(s):

J. Kuhn ◽

D. Lenartz ◽

Jürgen K. Mai ◽

W. Huff ◽

S.-H. Lee ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Nucleus Accumbens ◽

Tourette Syndrome ◽

Brain Stimulation ◽

Internal Capsule ◽

Deep Brain ◽

Stimulation Of

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Deep brain stimulation for the treatment of disorders of consciousness and cognition in traumatic brain injury patients: a review

Neurosurgical FOCUS ◽

10.3171/2018.5.focus18168 ◽

2018 ◽

Vol 45 (2) ◽

pp. E14 ◽

Cited By ~ 11

Author(s):

Bornali Kundu ◽

Andrea A. Brock ◽

Dario J. Englot ◽

Christopher R. Butson ◽

John D. Rolston

Keyword(s):

Traumatic Brain Injury ◽

Executive Function ◽

Deep Brain Stimulation ◽

Brain Injury ◽

Brain Stimulation ◽

Minimally Conscious State ◽

Disorders Of Consciousness ◽

Future Research ◽

Attention And Memory ◽

Deep Brain

Traumatic brain injury (TBI) is a looming epidemic, growing most rapidly in the elderly population. Some of the most devastating sequelae of TBI are related to depressed levels of consciousness (e.g., coma, minimally conscious state) or deficits in executive function. To date, pharmacological and rehabilitative therapies to treat these sequelae are limited. Deep brain stimulation (DBS) has been used to treat a number of pathologies, including Parkinson disease, essential tremor, and epilepsy. Animal and clinical research shows that targets addressing depressed levels of consciousness include components of the ascending reticular activating system and areas of the thalamus. Targets for improving executive function are more varied and include areas that modulate attention and memory, such as the frontal and prefrontal cortex, fornix, nucleus accumbens, internal capsule, thalamus, and some brainstem nuclei. The authors review the literature addressing the use of DBS to treat higher-order cognitive dysfunction and disorders of consciousness in TBI patients, while also offering suggestions on directions for future research.

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