Department of Psychiatry, Academic Medical Center, Amsterdam; Brain Imaging Center, Academic Medical Center, Amsterdam.
Department of Psychiatry, Academic Medical Center, Amsterdam.
Biol Psychiatry. 2014 Apr 15;75(8):647-52. doi: 10.1016/j.biopsych.2013.06.021. Epub 2013 Aug 12.
Obsessive-compulsive disorder is a chronic psychiatric disorder related to dysfunctional dopaminergic neurotransmission. Deep brain stimulation (DBS) targeted at the nucleus accumbens (NAc) has recently become an effective treatment for therapy-refractory obsessive-compulsive disorder, but its effect on dopaminergic transmission is unknown.
We measured the effects of NAc DBS in 15 patients on the dopamine D2/3 receptor availability in the striatum with [(123)I]iodobenzamide ([(123)I]IBZM) single photon emission computed tomography. We correlated changes in [(123)I]IBZM binding potential (BP) with plasma levels of homovanillic acid (HVA) and clinical symptoms.
Acute (1-hour) and chronic (1-year) DBS decreased striatal [(123)I]IBZM BP compared with the nonstimulated condition in the putamen. BP decreases were observed after 1 hour of stimulation, and chronic stimulation was related to concurrent HVA plasma elevations, implying DBS-induced dopamine release. BP decreases in the area directly surrounding the electrodes were significantly correlated with changes in clinical symptoms (45% symptom decrease).
NAc DBS induced striatal dopamine release, which was associated with increased HVA plasma levels and improved clinical symptoms, suggesting that DBS may compensate for a defective dopaminergic system.
强迫症是一种与多巴胺能神经传递功能障碍相关的慢性精神疾病。针对伏隔核（NAc）的深部脑刺激（DBS）最近已成为治疗难治性强迫症的有效方法，但它对多巴胺能传递的影响尚不清楚。
我们使用[(123)I]碘苯甲酰胺([(123)I]IBZM)单光子发射计算机断层扫描，测量了 15 例强迫症患者 NAc-DBS 对纹状体中多巴胺 D2/3 受体可及性的影响。我们将[(123)I]IBZM 结合潜能 (BP) 的变化与血浆高香草酸 (HVA) 和临床症状相关联。
与非刺激状态相比，急性（1 小时）和慢性（1 年）DBS 降低了壳核中的[(123)I]IBZM BP。刺激 1 小时后观察到 BP 下降，慢性刺激与同时升高的 HVA 血浆水平相关，表明 DBS 诱导多巴胺释放。电极直接周围区域的 BP 下降与临床症状的变化显著相关（症状减轻 45%）。
NAc-DBS 诱导纹状体多巴胺释放，与 HVA 血浆水平升高和临床症状改善相关，表明 DBS 可能补偿多巴胺能系统的缺陷。
