Deep Brain Stimulation for Obsessive-Compulsive Disorder: Optimal Stimulation Sites.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Meyer Garance M, Hollunder Barbara, Li Ningfei, Butenko Konstantin, Dembek Till A, Hart Lauren, Nombela Cristina, Mosley Philip, Akram Harith, Acevedo Nicola, Borron Benjamin M, Chou Tina, Castaño Montoya Juan Pablo, Strange Bryan, Barcia Juan A, Tyagi Himanshu, Castle David J, Smith Andrew H, Choi Ki Sueng, Kopell Brian H, Mayberg Helen S, Sheth Sameer A, Goodman Wayne K, Leentjens Albert F G, Richardson R Mark, Rossell Susan L, Bosanac Peter, Cosgrove G Rees, Kuhn Jens, Visser-Vandewalle Veerle, Figee Martijn, Dougherty Darin D, Siddiqi Shan H, Zrinzo Ludvic, Joyce Eileen, Baldermann Juan Carlos, Fox Michael D, Neudorfer Clemens, Horn Andreas
Аннотация
METHODS: Here, we retrospectively studied a multicenter cohort of 82 patients with OCD who underwent DBS of the ventral capsule/ventral striatum and mapped optimal stimulation sites in this region.
RESULTS: DBS sweet-spot mapping performed on a discovery set of 58 patients revealed 2 optimal stimulation sites associated with improvements on the Yale-Brown Obsessive Compulsive Scale, one in the anterior limb of the internal capsule that overlapped with a previously identified OCD-DBS response tract and one in the region of the inferior thalamic peduncle and bed nucleus of the stria terminalis. Critically, the nucleus accumbens proper and anterior commissure were associated with beneficial but suboptimal clinical improvements. Moreover, overlap with the resulting sweet- and sour-spots significantly estimated variance in outcomes in an independent cohort of 22 patients from 2 additional DBS centers. Finally, beyond obsessive-compulsive symptoms, stimulation of the anterior site was associated with optimal outcomes for both depression and anxiety, while the posterior site was only associated with improvements in depression.
CONCLUSIONS: Our results suggest how to refine targeting of DBS in OCD and may be helpful in guiding DBS programming in existing patients.