Baldermann Juan Carlos, Bohn Karl Peter, Hammes Jochen, Schüller Canan Beate, Visser-Vandewalle Veerle, Drzezga Alexander, Kuhn Jens
Department of Psychiatry and Psychotherapy, University of Cologne, Medical faculty, 50937 Cologne, Germany.
Department of Nuclear Medicine, University of Cologne, Medical faculty, 50937 Cologne, Germany.
Brain Sci. 2019 Aug 30;9(9):220. doi: 10.3390/brainsci9090220.
Recent approaches have suggested that deep brain stimulation (DBS) for obsessive-compulsive disorder relies on distributed networks rather than local brain modulation. However, there is insufficient data on how DBS affects brain metabolism both locally and globally. We enrolled three patients with treatment-refractory obsessive-compulsive disorder with ongoing DBS of the bilateral ventral capsule/ventral striatum. Patients underwent resting-state F-fluorodeoxyglucose and positron emission tomography in both stimulation ON and OFF conditions. All subjects showed relative hypometabolism in prefronto-basal ganglia-thalamic networks compared to a healthy control cohort when stimulation was switched OFF. Switching the stimulation ON resulted in differential changes in brain metabolism. Locally, volumes of activated tissue at stimulation sites ( = 6) showed a significant increase in metabolism during DBS ON compared to DBS OFF (Mean difference 4.5 % ± SD 2.8; = 0.012). Globally, differential changes were observed across patients encompassing prefrontal increase in metabolism in ON vs. OFF condition. Bearing in mind limitations of the small sample size, we conclude that DBS of the ventral capsule/ventral striatum for obsessive-compulsive disorder increases brain metabolism locally. Across distributed global networks, DBS appears to exert differential effects, possibly depending on localization of stimulation sites and response to the intervention.
最近的研究方法表明，用于治疗强迫症的深部脑刺激（DBS）依赖于分布式网络而非局部脑调节。然而，关于DBS如何在局部和整体上影响脑代谢的数据并不充分。我们招募了三名患有难治性强迫症且正在接受双侧腹侧囊/腹侧纹状体DBS治疗的患者。患者在刺激开启和关闭状态下均接受了静息态F-氟脱氧葡萄糖正电子发射断层扫描。与健康对照队列相比，在刺激关闭时，所有受试者在前额叶-基底神经节-丘脑网络中均表现出相对代谢减低。开启刺激导致脑代谢出现差异变化。在局部，刺激部位（n = 6）的激活组织体积在DBS开启时相较于DBS关闭时显示出代谢显著增加（平均差异4.5%±标准差2.8；p = 0.012）。在整体上，不同患者之间观察到差异变化，包括在刺激开启与关闭状态下前额叶代谢增加。考虑到样本量小的局限性，我们得出结论，用于强迫症的腹侧囊/腹侧纹状体DBS可局部增加脑代谢。在分布式的整体网络中，DBS似乎发挥着不同的作用，这可能取决于刺激部位的定位以及对干预的反应。
