Division of Psychiatry, Department of Clinical Sciences, Umeå University, 90187, Umeå, Sweden.
Department of Biomedical Engineering, Linköping University, Linköping, Sweden.
Acta Neurochir (Wien). 2022 Jan;164(1):193-202. doi: 10.1007/s00701-021-04991-0. Epub 2021 Oct 15.
BACKGROUND: Deep brain stimulation (DBS) is being investigated as a treatment for therapy-refractory obsessive compulsive disorder (OCD). Many different brain targets are being trialled. Several of these targets such as the ventral striatum (including the nucleus accumbens (NAc)), the ventral capsule, the inferior thalamic peduncle, and the bed nucleus of stria terminalis (BNST)) belong to the same network, are anatomically very close to one another, or even overlap. Data is still missing on how various stimulation parameters in a given target will affect surrounding anatomical areas and impact the clinical outcome of DBS. METHODS: In a pilot study of eleven participants with DBS of the BNST, we investigate through patient-specific simulation of electric field, which anatomical areas are affected by the electric field, and if this can be related to the clinical results. Our study combined individual patient's stimulation parameters at 12- and 24-month follow-up with image data from the preoperative MRI and postoperative CT. These data were used to calculate the distribution of electric field and create individual anatomical models of the field of stimulation. RESULTS: The individual electric stimulation fields by stimulation in the BNST were similar at both the 12- and 24-month follow-up, involving mainly anterior limb of the internal capsule (ALIC), genu of the internal capsule (IC), BNST, fornix, anteromedial globus pallidus externa (GPe), and the anterior commissure. A statistical significant correlation (p < 0.05) between clinical effect measured by the Yale-Brown Obsessive Compulsive Scale and stimulation was found at the 12-month follow-up in the ventral ALIC and anteromedial GPe. CONCLUSIONS: Many of the targets under investigation for OCD are in anatomical proximity. As seen in our study, off-target effects are overlapping. Therefore, DBS in the region of ALIC, NAc, and BNST may perhaps be considered to be stimulation of the same target.
背景:深部脑刺激 (DBS) 正被研究用于治疗难治性强迫症 (OCD)。许多不同的大脑靶点正在被试验。这些靶点中的一些,如腹侧纹状体(包括伏隔核 (NAc))、腹侧壳核、下丘脑脚和终纹床核 (BNST)),属于同一网络,在解剖上彼此非常接近,甚至重叠。关于给定靶点中的各种刺激参数如何影响周围解剖区域以及影响 DBS 的临床效果的数据仍然缺失。
方法:在对 11 名 BNST 接受 DBS 的患者进行的一项试点研究中,我们通过对电场的患者特异性模拟来研究哪些解剖区域受到电场的影响,以及这是否与临床结果相关。我们的研究将患者在 12 个月和 24 个月随访时的刺激参数与术前 MRI 和术后 CT 的图像数据相结合。这些数据用于计算电场的分布并创建刺激的个体解剖模型。
结果:BNST 刺激时的个体电刺激场在 12 个月和 24 个月的随访时相似,主要涉及内囊前肢 (ALIC)、内囊膝部 (IC)、BNST、穹窿、内囊前肢外侧苍白球 (GPe) 和前连合。在 12 个月的随访中,耶鲁-布朗强迫症量表 (Yale-Brown Obsessive Compulsive Scale) 测量的临床效果与刺激之间存在统计学显著相关性 (p<0.05) 在腹侧 ALIC 和内囊前肢 GPe。
结论:许多正在研究的 OCD 靶点在解剖上很接近。正如我们的研究所示,脱靶效应是重叠的。因此,ALIC、NAc 和 BNST 区域的 DBS 可能被认为是同一靶点的刺激。
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