Rauch Scott L, Dougherty Darin D, Malone Donald, Rezai Ali, Friehs Gerhard, Fischman Alan J, Alpert Nathaniel M, Haber Suzanne N, Stypulkowski Paul H, Rise Mark T, Rasmussen Steven A, Greenberg Benjamin D
Division of Psychiatric Neuroscience Research and Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts 02129, USA.
J Neurosurg. 2006 Apr;104(4):558-65. doi: 10.3171/jns.2006.104.4.558.
Deep brain stimulation (DBS) of the ventral [anterior internal] capsule/ventral striatum (VC/VS) is under investigation as an alternative to anterior capsulotomy for severe obsessive-compulsive disorder (OCD). In neuroimaging studies of patients with OCD, dysfunction in the orbitofrontal and anterior cingulate cortex, striatum, and thalamus has been identified; and modulation of activity in this circuit has been observed following successful nonsurgical treatment. The purpose of the current study was to test hypotheses regarding changes in regional cerebral blood flow (rCBF) during acute DBS at the VC/VS target in patients with OCD who were participating in a clinical DBS trial.
Six patients enrolled in a DBS trial for OCD underwent positron emission tomography to measure rCBF; the rCBF measured during acute DBS at high frequency was then compared with those measured during DBS at low frequency and off (control) conditions. On the basis of neuroanatomical knowledge about the VC/VS and neuroimaging data on OCD, the authors predicted that acute DBS at this target would result in modulation of activity within the implicated frontal-basal ganglia-thalamic circuit. Data were analyzed using statistical parametric mapping. In a comparison of acute high-frequency DBS with control conditions, the authors found significant activation of the orbitofrontal cortex, anterior cingulate cortex, striatum, globus pallidus, and thalamus.
Acute DBS at the VC/VS target is associated with activation of the circuitry implicated in OCD. Further studies will be necessary to replicate these findings and to determine the neural effects associated with chronic VC/VS DBS. Moreover, additional data are needed to investigate whether pretreatment imaging profiles can be used to predict a patient's subsequent clinical response to chronic DBS.
腹侧[前内侧]囊/腹侧纹状体（VC/VS）的深部脑刺激（DBS）作为重度强迫症（OCD）的前扣带切开术替代方案正在研究中。在强迫症患者的神经影像学研究中，已确定眶额皮质、前扣带回皮质、纹状体和丘脑存在功能障碍；并且在成功的非手术治疗后观察到该回路活动的调节。本研究的目的是检验关于参与临床DBS试验的强迫症患者在VC/VS靶点进行急性DBS期间局部脑血流（rCBF）变化的假设。
6名参加强迫症DBS试验的患者接受正电子发射断层扫描以测量rCBF；然后将高频急性DBS期间测量的rCBF与低频DBS和关闭（对照）状态下测量的rCBF进行比较。基于关于VC/VS的神经解剖学知识和强迫症的神经影像学数据，作者预测该靶点的急性DBS将导致相关的额叶 - 基底神经节 - 丘脑回路内的活动调节。使用统计参数映射分析数据。在急性高频DBS与对照状态的比较中，作者发现眶额皮质、前扣带回皮质、纹状体、苍白球和丘脑有显著激活。
VC/VS靶点的急性DBS与强迫症相关回路的激活有关。需要进一步研究来重复这些发现并确定与慢性VC/VS DBS相关的神经效应。此外，还需要更多数据来研究预处理成像特征是否可用于预测患者对慢性DBS的后续临床反应。
