Okun Michael S, Mann Giselle, Foote Kelly D, Shapira Nathan A, Bowers Dawn, Springer Utaka, Knight William, Martin Pamela, Goodman Wayne K
Department of Neurology, Movement Disorders Center, University of Florida, PO Box 100236, Gainesville, FL 32610, USA.
J Neurol Neurosurg Psychiatry. 2007 Mar;78(3):310-4. doi: 10.1136/jnnp.2006.095315. Epub 2006 Sep 29.
Recently, anterior limb of the internal capsule and nucleus accumbens deep brain stimulation (DBS) has been used in the treatment of medication-refractory obsessive-compulsive disorder (OCD). This region has been previously explored with lesion therapy, but with the advent of DBS there exists the possibility of monitoring the acute and chronic effects of electrical stimulation. The stimulation-induced benefits and side effects can be reversibly and blindly applied to a variety of locations in this region.
To explore the acute effects of DBS in the anterior limb of the internal capsule and nucleus accumbens region.
Ten total DBS leads in five patients with chronic and severe treatment-refractory OCD were tested. Patients were examined 30 days after DBS placement and received either "sham" testing or actual testing of the acute effects of DBS (the alternative condition tested 30 days later).
Pooled responses were reviewed for comparability of distribution using standard descriptive methods, and relationships between the variables of interest were sought using chi2 analysis. A total of 845 stimulation trials across the five patients were recorded and pooled. Of these 16% were elicited from sham stimulation and 17% from placebo (0 V stimulation). A comparison of active to sham trials showed that sham stimulation was not associated with significant side effects or responses from patients. Non-mood-related responses were found to be significantly associated with the ventral lead contacts (0 and 1) (p = 0.001). Responses such as taste, smell and smile were strongly associated with the most ventral lead positions. Similarly, physiological responses--for example, autonomic changes, increased breathing rate, sweating, nausea, cold sensation, heat sensation, fear, panic and panic episodes--were significantly associated with ventral stimulation (p = 0.001). Fear and panic responses appeared clustered around the most ventral electrode (0). Acute stimulation resulted in either improved or worsened mood responses in both the dorsal and ventral regions of the anterior limb of the internal capsule.
The acute effects of DBS in the region of the anterior limb of the internal capsule and nucleus accumbens, particularly when obtained in a blinded fashion, provide a unique opportunity to localise brain regions and explore circuitry.
最近，内囊前肢和伏隔核深部脑刺激（DBS）已被用于治疗难治性强迫症（OCD）。该区域此前已通过毁损疗法进行过探索，但随着DBS的出现，有可能监测电刺激的急性和慢性影响。刺激诱导的益处和副作用可以可逆且盲目地应用于该区域的多个位置。
探讨DBS在内囊前肢和伏隔核区域的急性影响。
对5例慢性重度难治性OCD患者的10根DBS电极进行测试。在DBS植入后30天对患者进行检查，并接受“假”测试或DBS急性影响的实际测试（另一种情况在30天后测试）。
使用标准描述性方法对汇总反应进行分布可比性审查，并使用卡方分析寻找感兴趣变量之间的关系。记录并汇总了5例患者的845次刺激试验。其中16%来自假刺激，17%来自安慰剂（0V刺激）。活性试验与假试验的比较表明，假刺激与患者的显著副作用或反应无关。发现与情绪无关的反应与腹侧电极触点（0和1）显著相关（p = 0.001）。味觉、嗅觉和微笑等反应与最腹侧的电极位置密切相关。同样，生理反应——例如，自主神经变化、呼吸频率增加、出汗、恶心、冷感、热感、恐惧、惊恐和惊恐发作——与腹侧刺激显著相关（p = 0.001）。恐惧和惊恐反应似乎集中在最腹侧的电极（0）周围。急性刺激导致内囊前肢背侧和腹侧区域的情绪反应改善或恶化。
DBS在内囊前肢和伏隔核区域的急性影响，特别是以盲法获得时，为定位脑区和探索神经回路提供了独特的机会。
