Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Neurosci Biobehav Rev. 2013 Mar;37(3):328-39. doi: 10.1016/j.neubiorev.2013.01.005. Epub 2013 Jan 11.
Treatment efficacy of deep brain stimulation (DBS) and other neurosurgical techniques in refractory obsessive-compulsive disorder (OCD) is greatly dependent on the targeting of relevant brain regions. Over the years, several case reports have been published on either the emergence or resolution of obsessive-compulsive symptoms due to neurological lesions. These reports can potentially serve as an important source of insight into the neuroanatomy of compulsivity and have implications for targets of DBS. For this purpose, we have reviewed all published case reports of patients with acquired or resolved obsessive-compulsive symptoms after brain lesions. We found a total of 37 case reports describing 71 patients with acquired and 6 with resolved obsessive-compulsive symptoms as a result of hemorrhaging, infarctions or removal of tumors. Behavioral symptoms following brain lesions consisted of typical obsessive-compulsive symptoms, but also symptoms within the compulsivity spectrum. These data suggests that lesions in the cortico-striato-thalamic circuit, parietal and temporal cortex, cerebellum and brainstem may induce compulsivity. Moreover, the resolution of obsessive-compulsive symptoms has been reported following lesions in the putamen, internal capsule and fronto-parietal lobe. These case reports provide strong evidence supporting the rationale for DBS in the ventral striatum and internal capsule for treatment of compulsivity and reveal the putamen and fronto-parietal cortex as promising new targets.
深部脑刺激 (DBS) 和其他神经外科技术治疗难治性强迫症 (OCD) 的疗效在很大程度上取决于相关脑区的靶向性。多年来，已经发表了几篇关于由于神经病变而出现或消除强迫症症状的病例报告。这些报告可能成为深入了解强迫性神经解剖结构的重要来源，并对 DBS 的靶点具有启示意义。为此，我们回顾了所有已发表的关于脑损伤后获得性或消除强迫症症状的病例报告。我们共发现 37 篇病例报告，描述了 71 例因出血、梗死或肿瘤切除而获得性强迫症症状的患者，以及 6 例强迫症症状缓解的患者。脑损伤后的行为症状包括典型的强迫症症状，但也包括强迫症状谱内的症状。这些数据表明，皮质纹状体丘脑回路、顶叶和颞叶皮质、小脑和脑干的病变可能会引起强迫性。此外，已有报道称，在壳核、内囊和额顶叶脑损伤后强迫症症状得到缓解。这些病例报告为 DBS 在治疗强迫症时在腹侧纹状体和内囊的应用提供了强有力的证据，并揭示了壳核和额顶叶皮质作为有前途的新靶点。
