Georgiev Dejan, Akram Harith, Jahanshahi Marjan
Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia.
Psychoradiology. 2021 Oct 4;1(3):118-151. doi: 10.1093/psyrad/kkab012. eCollection 2021 Sep.
Following the established application of deep brain stimulation (DBS) in the treatment of movement disorders, new non-neurological indications have emerged, such as for obsessive-compulsive disorders, major depressive disorder, dementia, Gilles de la Tourette Syndrome, anorexia nervosa, and addictions. As DBS is a network modulation surgical treatment, the development of DBS for both neurological and psychiatric disorders has been partly driven by advances in neuroimaging, which has helped explain the brain networks implicated. Advances in magnetic resonance imaging connectivity and electrophysiology have led to the development of the concept of modulating widely distributed, complex brain networks. Moreover, the increasing number of targets for treating psychiatric disorders have indicated that there may be a convergence of the effect of stimulating different targets for the same disorder, and the effect of stimulating the same target for different disorders. The aim of this paper is to review the imaging studies of DBS for psychiatric disorders. Imaging, and particularly connectivity analysis, offers exceptional opportunities to better understand and even predict the clinical outcomes of DBS, especially where there is a lack of objective biomarkers that are essential to properly guide DBS pre- and post-operatively. In future, imaging might also prove useful to individualize DBS treatment. Finally, one of the most important aspects of imaging in DBS is that it allows us to better understand the brain through observing the changes of the functional connectome under neuromodulation, which may in turn help explain the mechanisms of action of DBS that remain elusive.
随着深部脑刺激（DBS）在运动障碍治疗中的既定应用，新的非神经学适应症已经出现，如强迫症、重度抑郁症、痴呆症、图雷特综合征、神经性厌食症和成瘾症。由于DBS是一种网络调节性手术治疗，神经影像学的进展在一定程度上推动了DBS在神经学和精神疾病方面的发展，这有助于解释所涉及的脑网络。磁共振成像连接性和电生理学的进展导致了调节广泛分布的复杂脑网络这一概念的发展。此外，用于治疗精神疾病的靶点数量不断增加，这表明针对同一疾病刺激不同靶点的效果以及针对不同疾病刺激同一靶点的效果可能存在趋同。本文的目的是综述DBS治疗精神疾病的影像学研究。影像学，尤其是连接性分析，为更好地理解甚至预测DBS的临床结果提供了绝佳机会，特别是在缺乏客观生物标志物的情况下，而这些生物标志物对于正确指导DBS手术前后至关重要。未来，影像学也可能被证明对个性化DBS治疗有用。最后，DBS影像学最重要的一个方面是，它使我们能够通过观察神经调节下功能连接组的变化来更好地理解大脑，这反过来可能有助于解释DBS难以捉摸的作用机制。
