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Four Deep Brain Stimulation Targets for Obsessive-Compulsive Disorder: Are They Different?
Biological Psychiatry ( IF 9.6 ) Pub Date : 2020-07-25 , DOI: 10.1016/j.biopsych.2020.06.031
Suzanne N Haber 1 , Anastasia Yendiki 2 , Saad Jbabdi 3
Affiliation  

Deep brain stimulation is a promising therapeutic approach for patients with treatment-resistant obsessive-compulsive disorder, a condition linked to abnormalities in corticobasal ganglia networks. Effective targets are placed in one of four subcortical areas with the goal of capturing prefrontal, anterior cingulate, and basal ganglia connections linked to the limbic system. These include the anterior limb of the internal capsule, the ventral striatum, the subthalamic nucleus, and a midbrain target. The goal of this review is to examine these 4 targets with respect to the similarities and differences of their connections. Following a review of the connections for each target based on anatomic studies in nonhuman primates, we examine the accuracy of diffusion magnetic resonance imaging tractography to replicate those connections in nonhuman primates, before evaluating the connections in the human brain based on diffusion magnetic resonance imaging tractography. Results demonstrate that the four targets generally involve similar connections, all of which are part of the internal capsule. Nonetheless, some connections are unique to each site. Delineating the similarities and differences across targets is a critical step for evaluating and comparing the effectiveness of each and how circuits contribute to the therapeutic outcome. It also underscores the importance that the terminology used for each target accurately reflects its position and its anatomic connections, so as to enable comparisons across clinical studies and for basic scientists to probe mechanisms underlying deep brain stimulation.



中文翻译:

强迫症的四个深部脑刺激目标:它们有什么不同吗?

对于患有难治性强迫症的患者来说,深部脑刺激是一种很有前途的治疗方法,这种疾病与皮质基底神经节网络的异常有关。有效目标位于四个皮层下区域之一,目的是捕获与边缘系统相关的前额叶、前扣带和基底神经节连接。这些包括内囊的前肢、腹侧纹状体、底丘脑核和中脑目标。本综述的目的是检查这 4 个目标之间的相似点和不同点。根据对非人类灵长类动物的解剖学研究,对每个目标的联系进行审查后,在基于扩散磁共振成像纤维束成像评估人脑中的连接之前,我们检查了弥散磁共振成像纤维束成像技术在非人类灵长类动物中复制这些连接的准确性。结果表明,四个目标通常涉及相似的连接,所有这些连接都是内囊的一部分。尽管如此,某些连接对于每个站点都是唯一的。描述目标之间的异同是评估和比较每个目标的有效性以及电路如何促进治疗结果的关键步骤。它还强调了用于每个目标的术语准确反映其位置及其解剖连接的重要性,

更新日期:2020-07-25
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