Kim Min Jae, Butala Ankur, Salimpour Yousef, Sawa Akira, Figee Martijn, Choi Ki Sueng, Schretlen David, Mills Kelly A, Cascella Nicola
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD.
medRxiv. 2025 Apr 13:2025.04.09.25325419. doi: 10.1101/2025.04.09.25325419.
Deep brain stimulation (DBS) of the substantia nigra pars reticulata (SNpr) is under investigation for managing auditory-verbal hallucinations (AVH) in treatment-resistant schizophrenia (TR-SZ). We assessed acute AVH suppression during initial SNpr-DBS programming in three TR-SZ patients and mapped associated brain network engagement using normative connectomes. One-month post-implantation, monopolar stimulation at each electrode contact was evaluated for its effect on AVH severity. Volumes of tissue activation (VTA) were integrated with normative structural and functional connectivity data to generate individualized network maps. Among 86 VTAs, stimulation sites associated with greatest AVH relief localized to left anterior-dorsal and right posterior-ventral SNpr. Greater AVH suppression correlated with structural connectivity to sensorimotor cortex, precuneus, angular and supramarginal gyri, and functional connectivity to the mediodorsal thalamus, orbitofrontal cortex, anterior cingulate, and dorsolateral prefrontal cortex. These preliminary results highlight specific SNpr subregions and circuits linked to acute symptom reduction, supporting the potential of network-targeted DBS for TR-SZ.
黑质网状部(SNpr)的深部脑刺激(DBS)正在研究中,用于治疗难治性精神分裂症(TR-SZ)的幻听(AVH)。我们评估了3例TR-SZ患者在初次SNpr-DBS编程期间的急性AVH抑制情况,并使用标准连接组绘制相关脑网络参与情况。植入后1个月,评估每个电极触点的单极刺激对AVH严重程度的影响。将组织激活体积(VTA)与标准结构和功能连接数据相结合,生成个性化网络图谱。在86个体积组织激活区域中,与最大程度缓解AVH相关的刺激部位定位于左侧前背侧和右侧后腹侧SNpr。更大程度的AVH抑制与与感觉运动皮层、楔前叶、角回和缘上回的结构连接,以及与背内侧丘脑、眶额皮层、前扣带回和背外侧前额叶皮层的功能连接相关。这些初步结果突出了与急性症状减轻相关的特定SNpr亚区域和回路,支持了针对网络的DBS治疗TR-SZ的潜力。