Acute deep brain stimulation changes in regional cerebral blood flow in obsessive-compulsive disorder

Darin D. Dougherty; Tina Chou; Andrew K. Corse; Amanda R. Arulpragasam; Alik S. Widge; Cristina Cusin; Karleyton C. Evans; Benjamin D. Greenberg; Suzanne N. Haber; Thilo Deckersbach

doi:10.3171/2015.9.JNS151387

Acute deep brain stimulation changes in regional cerebral blood flow in obsessive-compulsive disorder

Darin D. Dougherty, Tina Chou, Andrew K. Corse, Amanda R. Arulpragasam, Alik S. Widge, Cristina Cusin, Karleyton C. Evans, Benjamin D. Greenberg, Suzanne N. Haber, Thilo Deckersbach

Research output: Contribution to journal › Article › peer-review

34 Scopus citations

Abstract

Objective Deep brain stimulation (DBS) is a reversible, nonlesion-based treatment for patients with intractable obsessive-compulsive disorder (OCD). The frst studies on DBS for OCD stimulating the ventral capsule/ventral striatum (VC/VS) yielded encouraging results for this neuroanatomical site's therapeutic effcacy. This investigation was conducted to better understand which regions of the cortico-striatal-thalamic-cortical network were acutely affected by VC/VS DBS for OCD. Furthermore, the objective was to identify which brain regions demonstrated changes in perfusion, as stimulation was applied across a dorsoventral lead axis that corresponded to different anatomical locations in the VC/VS. methods Six patients receiving VC/VS DBS for OCD underwent oxygen-15 positron emission tomography (¹⁵O-PET) scanning. Monopolar DBS was delivered at each of the 4 different electrodes on the stimulating lead in the VC/VS. The data were analyzed using SPM5. Paired t-tests were run in SPSS to identify signifcant changes in regional cerebral blood flow (rCBF) between stimulation conditions. Pearson's r correlations were run between these signifcant changes in rCBF and changes in OCD and depressive symptom severity. results Perfusion in the dorsal anterior cingulate cortex (dACC) signifcantly increased when monopolar DBS was turned on at the most ventral DBS contact, and this increase in dACC activity was correlated with reductions in depressive symptom severity (r(5) =-0.994, p = 0.001). Perfusion in the thalamus, striatum, and globus pallidus signifcantly increased when DBS was turned on at the most dorsal contact. conclusions DBS of the VC/VS appears to modulate activity in the regions implicated in the pathophysiology of OCD. Different regions in the cortico-striatal-thalamic-cortical circuit showed increased perfusion based on whether the stimulation was more ventral or dorsal along the lead axis in the VC/VS. Evidence was found that DBS at the most ventral site was associated with clinical changes in depressive symptom severity, but not OCD symptom severity.

Original language	English (US)
Pages (from-to)	1087-1093
Number of pages	7
Journal	Journal of neurosurgery
Volume	125
Issue number	5
DOIs	https://doi.org/10.3171/2015.9.JNS151387
State	Published - Nov 2016
Externally published	Yes

Bibliographical note

Funding Information:
Funded by DARPA, NIH, NIMH, National Institute on Aging, Agency for Healthcare Research &Quality, PCORI, Janssen Pharmaceuticals, The Forest Research Institute, Shire Development Inc., Medtronic, Cyberonics, Northstar, and Takeda.

Publisher Copyright:
© 2016 AANS.

Keywords

Cortico-striatal-thalamic-cortical circuit
Deep brain stimulation
Functional neurosurgery
Obsessive-compulsive disorder
Positron emission tomography
Ventral capsule/ventral striatum

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@article{784eb1e263d9418386aae568f1c29164,

title = "Acute deep brain stimulation changes in regional cerebral blood flow in obsessive-compulsive disorder",

abstract = "Objective Deep brain stimulation (DBS) is a reversible, nonlesion-based treatment for patients with intractable obsessive-compulsive disorder (OCD). The frst studies on DBS for OCD stimulating the ventral capsule/ventral striatum (VC/VS) yielded encouraging results for this neuroanatomical site's therapeutic effcacy. This investigation was conducted to better understand which regions of the cortico-striatal-thalamic-cortical network were acutely affected by VC/VS DBS for OCD. Furthermore, the objective was to identify which brain regions demonstrated changes in perfusion, as stimulation was applied across a dorsoventral lead axis that corresponded to different anatomical locations in the VC/VS. methods Six patients receiving VC/VS DBS for OCD underwent oxygen-15 positron emission tomography (15O-PET) scanning. Monopolar DBS was delivered at each of the 4 different electrodes on the stimulating lead in the VC/VS. The data were analyzed using SPM5. Paired t-tests were run in SPSS to identify signifcant changes in regional cerebral blood flow (rCBF) between stimulation conditions. Pearson's r correlations were run between these signifcant changes in rCBF and changes in OCD and depressive symptom severity. results Perfusion in the dorsal anterior cingulate cortex (dACC) signifcantly increased when monopolar DBS was turned on at the most ventral DBS contact, and this increase in dACC activity was correlated with reductions in depressive symptom severity (r(5) =-0.994, p = 0.001). Perfusion in the thalamus, striatum, and globus pallidus signifcantly increased when DBS was turned on at the most dorsal contact. conclusions DBS of the VC/VS appears to modulate activity in the regions implicated in the pathophysiology of OCD. Different regions in the cortico-striatal-thalamic-cortical circuit showed increased perfusion based on whether the stimulation was more ventral or dorsal along the lead axis in the VC/VS. Evidence was found that DBS at the most ventral site was associated with clinical changes in depressive symptom severity, but not OCD symptom severity.",

keywords = "Cortico-striatal-thalamic-cortical circuit, Deep brain stimulation, Functional neurosurgery, Obsessive-compulsive disorder, Positron emission tomography, Ventral capsule/ventral striatum",

author = "Dougherty, {Darin D.} and Tina Chou and Corse, {Andrew K.} and Arulpragasam, {Amanda R.} and Widge, {Alik S.} and Cristina Cusin and Evans, {Karleyton C.} and Greenberg, {Benjamin D.} and Haber, {Suzanne N.} and Thilo Deckersbach",

note = "Funding Information: Funded by DARPA, NIH, NIMH, National Institute on Aging, Agency for Healthcare Research &Quality, PCORI, Janssen Pharmaceuticals, The Forest Research Institute, Shire Development Inc., Medtronic, Cyberonics, Northstar, and Takeda. Publisher Copyright: {\textcopyright} 2016 AANS.",

year = "2016",

month = nov,

doi = "10.3171/2015.9.JNS151387",

language = "English (US)",

volume = "125",

pages = "1087--1093",

journal = "Journal of neurosurgery",

issn = "0022-3085",

publisher = "American Association of Neurological Surgeons",

number = "5",

}

TY - JOUR

T1 - Acute deep brain stimulation changes in regional cerebral blood flow in obsessive-compulsive disorder

AU - Dougherty, Darin D.

AU - Chou, Tina

AU - Corse, Andrew K.

AU - Arulpragasam, Amanda R.

AU - Widge, Alik S.

AU - Cusin, Cristina

AU - Evans, Karleyton C.

AU - Greenberg, Benjamin D.

AU - Haber, Suzanne N.

AU - Deckersbach, Thilo

N1 - Funding Information: Funded by DARPA, NIH, NIMH, National Institute on Aging, Agency for Healthcare Research &Quality, PCORI, Janssen Pharmaceuticals, The Forest Research Institute, Shire Development Inc., Medtronic, Cyberonics, Northstar, and Takeda. Publisher Copyright: © 2016 AANS.

PY - 2016/11

Y1 - 2016/11

N2 - Objective Deep brain stimulation (DBS) is a reversible, nonlesion-based treatment for patients with intractable obsessive-compulsive disorder (OCD). The frst studies on DBS for OCD stimulating the ventral capsule/ventral striatum (VC/VS) yielded encouraging results for this neuroanatomical site's therapeutic effcacy. This investigation was conducted to better understand which regions of the cortico-striatal-thalamic-cortical network were acutely affected by VC/VS DBS for OCD. Furthermore, the objective was to identify which brain regions demonstrated changes in perfusion, as stimulation was applied across a dorsoventral lead axis that corresponded to different anatomical locations in the VC/VS. methods Six patients receiving VC/VS DBS for OCD underwent oxygen-15 positron emission tomography (15O-PET) scanning. Monopolar DBS was delivered at each of the 4 different electrodes on the stimulating lead in the VC/VS. The data were analyzed using SPM5. Paired t-tests were run in SPSS to identify signifcant changes in regional cerebral blood flow (rCBF) between stimulation conditions. Pearson's r correlations were run between these signifcant changes in rCBF and changes in OCD and depressive symptom severity. results Perfusion in the dorsal anterior cingulate cortex (dACC) signifcantly increased when monopolar DBS was turned on at the most ventral DBS contact, and this increase in dACC activity was correlated with reductions in depressive symptom severity (r(5) =-0.994, p = 0.001). Perfusion in the thalamus, striatum, and globus pallidus signifcantly increased when DBS was turned on at the most dorsal contact. conclusions DBS of the VC/VS appears to modulate activity in the regions implicated in the pathophysiology of OCD. Different regions in the cortico-striatal-thalamic-cortical circuit showed increased perfusion based on whether the stimulation was more ventral or dorsal along the lead axis in the VC/VS. Evidence was found that DBS at the most ventral site was associated with clinical changes in depressive symptom severity, but not OCD symptom severity.

AB - Objective Deep brain stimulation (DBS) is a reversible, nonlesion-based treatment for patients with intractable obsessive-compulsive disorder (OCD). The frst studies on DBS for OCD stimulating the ventral capsule/ventral striatum (VC/VS) yielded encouraging results for this neuroanatomical site's therapeutic effcacy. This investigation was conducted to better understand which regions of the cortico-striatal-thalamic-cortical network were acutely affected by VC/VS DBS for OCD. Furthermore, the objective was to identify which brain regions demonstrated changes in perfusion, as stimulation was applied across a dorsoventral lead axis that corresponded to different anatomical locations in the VC/VS. methods Six patients receiving VC/VS DBS for OCD underwent oxygen-15 positron emission tomography (15O-PET) scanning. Monopolar DBS was delivered at each of the 4 different electrodes on the stimulating lead in the VC/VS. The data were analyzed using SPM5. Paired t-tests were run in SPSS to identify signifcant changes in regional cerebral blood flow (rCBF) between stimulation conditions. Pearson's r correlations were run between these signifcant changes in rCBF and changes in OCD and depressive symptom severity. results Perfusion in the dorsal anterior cingulate cortex (dACC) signifcantly increased when monopolar DBS was turned on at the most ventral DBS contact, and this increase in dACC activity was correlated with reductions in depressive symptom severity (r(5) =-0.994, p = 0.001). Perfusion in the thalamus, striatum, and globus pallidus signifcantly increased when DBS was turned on at the most dorsal contact. conclusions DBS of the VC/VS appears to modulate activity in the regions implicated in the pathophysiology of OCD. Different regions in the cortico-striatal-thalamic-cortical circuit showed increased perfusion based on whether the stimulation was more ventral or dorsal along the lead axis in the VC/VS. Evidence was found that DBS at the most ventral site was associated with clinical changes in depressive symptom severity, but not OCD symptom severity.

KW - Cortico-striatal-thalamic-cortical circuit

KW - Deep brain stimulation

KW - Functional neurosurgery

KW - Obsessive-compulsive disorder

KW - Positron emission tomography

KW - Ventral capsule/ventral striatum

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Acute deep brain stimulation changes in regional cerebral blood flow in obsessive-compulsive disorder

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