Department of Pharmacology and Physiology, University of Rochester School of Medicine and Dentistry, Rochester, New York; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, Massachusetts.
Athinoula A. Martinos Center for Biomedical Imaging, Harvard University and Massachusetts General Hospital, Boston, Massachusetts.
Biol Psychiatry. 2021 Nov 15;90(10):667-677. doi: 10.1016/j.biopsych.2020.06.031. Epub 2020 Jul 25.
Deep brain stimulation is a promising therapeutic approach for patients with treatment-resistant obsessive-compulsive disorder, a condition linked to abnormalities in corticobasal ganglia networks. Effective targets are placed in one of four subcortical areas with the goal of capturing prefrontal, anterior cingulate, and basal ganglia connections linked to the limbic system. These include the anterior limb of the internal capsule, the ventral striatum, the subthalamic nucleus, and a midbrain target. The goal of this review is to examine these 4 targets with respect to the similarities and differences of their connections. Following a review of the connections for each target based on anatomic studies in nonhuman primates, we examine the accuracy of diffusion magnetic resonance imaging tractography to replicate those connections in nonhuman primates, before evaluating the connections in the human brain based on diffusion magnetic resonance imaging tractography. Results demonstrate that the four targets generally involve similar connections, all of which are part of the internal capsule. Nonetheless, some connections are unique to each site. Delineating the similarities and differences across targets is a critical step for evaluating and comparing the effectiveness of each and how circuits contribute to the therapeutic outcome. It also underscores the importance that the terminology used for each target accurately reflects its position and its anatomic connections, so as to enable comparisons across clinical studies and for basic scientists to probe mechanisms underlying deep brain stimulation.
深部脑刺激是一种有前途的治疗方法,适用于治疗抵抗性强迫症患者,这种疾病与皮质基底节网络异常有关。有效的靶点被放置在四个皮质下区域之一,目的是捕捉与边缘系统有关的前额叶、前扣带和基底节连接。这些区域包括内囊前肢、腹侧纹状体、丘脑底核和中脑靶点。本综述的目的是检查这 4 个靶点,以了解它们连接的相似性和差异性。在对非人类灵长类动物的解剖研究进行了每个靶点的连接回顾之后,我们检查了扩散磁共振成像轨迹技术在非人类灵长类动物中复制这些连接的准确性,然后根据扩散磁共振成像轨迹技术评估人类大脑中的连接。结果表明,这四个靶点通常涉及相似的连接,所有这些连接都是内囊的一部分。尽管如此,一些连接是每个部位所特有的。跨靶点描绘相似性和差异性是评估和比较每个靶点的有效性以及回路如何有助于治疗结果的关键步骤。它还强调了用于每个靶点的术语准确反映其位置和解剖连接的重要性,以便能够在临床研究之间进行比较,并使基础科学家能够探究深部脑刺激的机制。
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