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Mondragón-González SL, Schreiweis C, Burguière E. Closed-loop recruitment of striatal interneurons prevents compulsive-like grooming behaviors. Nat Neurosci 2024; 27:1148-1156. [PMID: 38693349 PMCID: PMC11156588 DOI: 10.1038/s41593-024-01633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Abstract
Compulsive behaviors have been associated with striatal hyperactivity. Parvalbumin-positive striatal interneurons (PVIs) in the striatum play a crucial role in regulating striatal activity and suppressing prepotent inappropriate actions. To investigate the potential role of striatal PVIs in regulating compulsive behaviors, we assessed excessive self-grooming-a behavioral metric of compulsive-like behavior-in male Sapap3 knockout mice (Sapap3-KO). Continuous optogenetic activation of PVIs in striatal areas receiving input from the lateral orbitofrontal cortex reduced self-grooming events in Sapap3-KO mice to wild-type levels. Aiming to shorten the critical time window for PVI recruitment, we then provided real-time closed-loop optogenetic stimulation of striatal PVIs, using a transient power increase in the 1-4 Hz frequency band in the orbitofrontal cortex as a predictive biomarker of grooming onsets. Targeted closed-loop stimulation at grooming onsets was as effective as continuous stimulation in reducing grooming events but required 87% less stimulation time, paving the way for adaptive stimulation therapeutic protocols.
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Affiliation(s)
- Sirenia Lizbeth Mondragón-González
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, AP-HP Hôpital de la Pitié Salpêtrière, Paris, France
| | - Christiane Schreiweis
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, AP-HP Hôpital de la Pitié Salpêtrière, Paris, France
| | - Eric Burguière
- Institut du Cerveau - Paris Brain Institute - ICM, Sorbonne Université, Inserm, CNRS, AP-HP Hôpital de la Pitié Salpêtrière, Paris, France.
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2
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Chen LL, Naesström M, Halvorsen M, Fytagoridis A, Crowley SB, Mataix-Cols D, Rück C, Crowley JJ, Pascal D. Genomics of severe and treatment-resistant obsessive-compulsive disorder treated with deep brain stimulation: A preliminary investigation. Am J Med Genet B Neuropsychiatr Genet 2024:e32983. [PMID: 38650085 DOI: 10.1002/ajmg.b.32983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 01/25/2024] [Accepted: 03/20/2024] [Indexed: 04/25/2024]
Abstract
Individuals with severe and treatment-resistant obsessive-compulsive disorder (trOCD) represent a small but severely disabled group of patients. Since trOCD cases eligible for deep brain stimulation (DBS) probably comprise the most severe end of the OCD spectrum, we hypothesize that they may be more likely to have a strong genetic contribution to their disorder. Therefore, while the worldwide population of DBS-treated cases may be small (~300), screening these individuals with modern genomic methods may accelerate gene discovery in OCD. As such, we have begun to collect DNA from trOCD cases who qualify for DBS, and here we report results from whole exome sequencing and microarray genotyping of our first five cases. All participants had previously received DBS in the bed nucleus of stria terminalis (BNST), with two patients responding to the surgery and one showing a partial response. Our analyses focused on gene-disruptive rare variants (GDRVs; rare, predicted-deleterious single-nucleotide variants or copy number variants overlapping protein-coding genes). Three of the five cases carried a GDRV, including a missense variant in the ion transporter domain of KCNB1, a deletion at 15q11.2, and a duplication at 15q26.1. The KCNB1 variant (hg19 chr20-47991077-C-T, NM_004975.3:c.1020G>A, p.Met340Ile) causes substitution of methionine for isoleucine in the trans-membrane region of neuronal potassium voltage-gated ion channel KV2.1. This KCNB1 substitution (Met340Ile) is located in a highly constrained region of the protein where other rare missense variants have previously been associated with neurodevelopmental disorders. The patient carrying the Met340Ile variant responded to DBS, which suggests that genetic factors could potentially be predictors of treatment response in DBS for OCD. In sum, we have established a protocol for recruiting and genomically characterizing trOCD cases. Preliminary results suggest that this will be an informative strategy for finding risk genes in OCD.
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Affiliation(s)
- Long Long Chen
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Matilda Naesström
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Matthew Halvorsen
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Anders Fytagoridis
- Department of Neurosurgery, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | | | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
| | - James J Crowley
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Diana Pascal
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
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Zrinzo L. Severe Refractory Obsessive Compulsive Disorder and Depression: Should We Consider Stereotactic Neurosurgery? Neuropsychiatr Dis Treat 2024; 20:469-478. [PMID: 38463457 PMCID: PMC10921944 DOI: 10.2147/ndt.s407210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 02/22/2024] [Indexed: 03/12/2024] Open
Abstract
Functional neurosurgery involves modulation of activity within neural circuits that drive pathological activity. Neurologists and neurosurgeons have worked closely together, advancing the field for over a century, such that neurosurgical procedures for movement disorders are now accepted as "standard of care", benefiting hundreds of thousands of patients. As with movement disorders, some neuropsychiatric illnesses, including obsessive compulsive disorder and depression, can be framed as disorders of neural networks. Over the past two decades, evidence has accumulated that stereotactic neurosurgery can help some patients with mental disorders. Nevertheless, despite the availability of class I evidence for some interventions, there is a huge mismatch between the prevalence of severe refractory mental disorders and the number of referrals made to specialised functional neurosurgery services. This paper examines the historical trajectory of neurosurgery for movement and mental disorders. A review of neurosurgical techniques, including stereotactic radiofrequency ablation, gamma knife, deep brain stimulation, and magnetic resonance imaging guided focused ultrasound, explains the high degree of safety afforded by technological advances in the field. Evidence from clinical trials supporting functional neurosurgery for mental disorders, including obsessive compulsive disorder and depression, is presented. An improved understanding of modern functional neurosurgery should foster collaboration between psychiatry and neurosurgery, providing hope to patients whose symptoms are refractory to all other treatments.
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Affiliation(s)
- Ludvic Zrinzo
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, London, UK
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4
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Acevedo N, Rossell S, Castle D, Groves C, Cook M, McNeill P, Olver J, Meyer D, Perera T, Bosanac P. Clinical outcomes of deep brain stimulation for obsessive-compulsive disorder: Insight as a predictor of symptom changes. Psychiatry Clin Neurosci 2024; 78:131-141. [PMID: 37984432 PMCID: PMC10952286 DOI: 10.1111/pcn.13619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 10/18/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
AIM Deep brain stimulation (DBS) is a safe and effective treatment option for people with refractory obsessive-compulsive disorder (OCD). Yet our understanding of predictors of response and prognostic factors remains rudimentary, and long-term comprehensive follow-ups are lacking. We aim to investigate the efficacy of DBS therapy for OCD patients, and predictors of clinical response. METHODS Eight OCD participants underwent DBS stimulation of the nucleus accumbens (NAc) in an open-label longitudinal trial, duration of follow-up varied between 9 months and 7 years. Post-operative care involved comprehensive fine tuning of stimulation parameters and adjunct multidisciplinary therapy. RESULTS Six participants achieved clinical response (35% improvement in obsessions and compulsions on the Yale Brown Obsessive Compulsive Scale (YBOCS)) within 6-9 weeks, response was maintained at last follow up. On average, the YBOCS improved by 45% at last follow up. Mixed linear modeling elucidated directionality of symptom changes: insight into symptoms strongly predicted (P = 0.008) changes in symptom severity during DBS therapy, likely driven by initial changes in depression and anxiety. Precise localization of DBS leads demonstrated that responders most often had their leads (and active contacts) placed dorsal compared to non-responders, relative to the Nac. CONCLUSION The clinical efficacy of DBS for OCD is demonstrated, and mediators of changes in symptoms are proposed. The symptom improvements within this cohort should be seen within the context of the adjunct psychological and biopsychosocial care that implemented a shared decision-making approach, with flexible iterative DBS programming. Further research should explore the utility of insight as a clinical correlate of response. The trial was prospectively registered with the ANZCTR (ACTRN12612001142820).
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Affiliation(s)
- Nicola Acevedo
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- St Vincent's HospitalMelbourneVictoriaAustralia
| | - Susan Rossell
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- St Vincent's HospitalMelbourneVictoriaAustralia
| | - David Castle
- St Vincent's HospitalMelbourneVictoriaAustralia
- Centre for Addiction and Mental HealthUniversity of TorontoTorontoOntarioCanada
| | | | - Mark Cook
- St Vincent's HospitalMelbourneVictoriaAustralia
| | | | - James Olver
- Department of PsychiatryUniversity of MelbourneMelbourneVictoriaAustralia
| | - Denny Meyer
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Thushara Perera
- Bionics InstituteEast MelbourneVictoriaAustralia
- Department of Medical BionicsThe University of MelbourneMelbourneVictoriaAustralia
| | - Peter Bosanac
- St Vincent's HospitalMelbourneVictoriaAustralia
- Department of PsychiatryUniversity of MelbourneMelbourneVictoriaAustralia
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Verhein JR, Vyas S, Shenoy KV. Methylphenidate modulates motor cortical dynamics and behavior. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.15.562405. [PMID: 37905157 PMCID: PMC10614820 DOI: 10.1101/2023.10.15.562405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Methylphenidate (MPH, brand: Ritalin) is a common stimulant used both medically and non-medically. Though typically prescribed for its cognitive effects, MPH also affects movement. While it is known that MPH noncompetitively blocks the reuptake of catecholamines through inhibition of dopamine and norepinephrine transporters, a critical step in exploring how it affects behavior is to understand how MPH directly affects neural activity. This would establish an electrophysiological mechanism of action for MPH. Since we now have biologically-grounded network-level hypotheses regarding how populations of motor cortical neurons plan and execute movements, there is a unique opportunity to make testable predictions regarding how systemic MPH administration - a pharmacological perturbation - might affect neural activity in motor cortex. To that end, we administered clinically-relevant doses of MPH to Rhesus monkeys as they performed an instructed-delay reaching task. Concomitantly, we measured neural activity from dorsal premotor and primary motor cortex. Consistent with our predictions, we found dose-dependent and significant effects on reaction time, trial-by-trial variability, and movement speed. We confirmed our hypotheses that changes in reaction time and variability were accompanied by previously established population-level changes in motor cortical preparatory activity and the condition-independent signal that precedes movements. We expected changes in speed to be a result of changes in the amplitude of motor cortical dynamics and/or a translation of those dynamics in activity space. Instead, our data are consistent with a mechanism whereby the neuromodulatory effect of MPH is to increase the gain and/or the signal-to-noise of motor cortical dynamics during reaching. Continued work in this domain to better understand the brain-wide electrophysiological mechanism of action of MPH and other psychoactive drugs could facilitate more targeted treatments for a host of cognitive-motor disorders.
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Affiliation(s)
- Jessica R Verhein
- Medical Scientist Training Program, Stanford School of Medicine, Stanford University, Stanford, CA
- Neurosciences Graduate Program, Stanford School of Medicine, Stanford University, Stanford, CA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA
- Current affiliations: Psychiatry Research Residency Training Program, University of California, San Francisco, San Francisco, CA
| | - Saurabh Vyas
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA
- Department of Bioengineering, Stanford University, Stanford, CA
- Mortimer B. Zuckerman Mind Brain Behavior Institute, Columbia University, New York, NY
| | - Krishna V Shenoy
- Neurosciences Graduate Program, Stanford School of Medicine, Stanford University, Stanford, CA
- Wu Tsai Neurosciences Institute, Stanford University, Stanford, CA
- Department of Bioengineering, Stanford University, Stanford, CA
- Department of Electrical Engineering, Stanford University, Stanford, CA
- Howard Hughes Medical Institute at Stanford University, Stanford, CA
- Department of Neurobiology, Stanford University, Stanford, CA
- Bio-X Program, Stanford University, Stanford, CA
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6
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Fanty L, Yu J, Chen N, Fletcher D, Hey G, Okun M, Wong J. The current state, challenges, and future directions of deep brain stimulation for obsessive compulsive disorder. Expert Rev Med Devices 2023; 20:829-842. [PMID: 37642374 DOI: 10.1080/17434440.2023.2252732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/27/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is clinically and pathologically heterogenous, with symptoms often refractory to first-line treatments. Deep brain stimulation (DBS) for the treatment of refractory OCD provides an opportunity to adjust and individualize neuromodulation targeting aberrant circuitry underlying OCD. The tailoring of DBS therapy may allow precision in symptom control based on patient-specific pathology. Progress has been made in understanding the potential targets for DBS intervention; however, a consensus on an optimal target has not been agreed upon. AREAS COVERED A literature review of DBS for OCD was performed by querying the PubMed database. The following topics were covered: the evolution of DBS targeting in OCD, the concept of an underlying unified connectomic network, current DBS targets, challenges facing the field, and future directions which could advance personalized DBS in this challenging population. EXPERT OPINION To continue the increasing efficacy of DBS for OCD, we must further explore the optimal DBS response across clinical profiles and neuropsychiatric domains of OCD as well as how interventions targeting multiple points in an aberrant circuit, multiple aberrant circuits, or a connectivity hub impact clinical response. Additionally, biomarkers would be invaluable in programming adjustments and creating a closed-loop paradigm to address symptom fluctuation in daily life.
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Affiliation(s)
- Lauren Fanty
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Jun Yu
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Nita Chen
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Drew Fletcher
- College of Medicine, University of Florida Health Science Center, Gainesville, FL, USA
| | - Grace Hey
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
- College of Medicine, University of Florida Health Science Center, Gainesville, FL, USA
| | - Michael Okun
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Josh Wong
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
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Hitti FL, Widge AS, Riva-Posse P, Malone DA, Okun MS, Shanechi MM, Foote KD, Lisanby SH, Ankudowich E, Chivukula S, Chang EF, Gunduz A, Hamani C, Feinsinger A, Kubu CS, Chiong W, Chandler JA, Carbunaru R, Cheeran B, Raike RS, Davis RA, Halpern CH, Vanegas-Arroyave N, Markovic D, Bick SK, McIntyre CC, Richardson RM, Dougherty DD, Kopell BH, Sweet JA, Goodman WK, Sheth SA, Pouratian N. Future directions in psychiatric neurosurgery: Proceedings of the 2022 American Society for Stereotactic and Functional Neurosurgery meeting on surgical neuromodulation for psychiatric disorders. Brain Stimul 2023; 16:867-878. [PMID: 37217075 PMCID: PMC11189296 DOI: 10.1016/j.brs.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/24/2023] Open
Abstract
OBJECTIVE Despite advances in the treatment of psychiatric diseases, currently available therapies do not provide sufficient and durable relief for as many as 30-40% of patients. Neuromodulation, including deep brain stimulation (DBS), has emerged as a potential therapy for persistent disabling disease, however it has not yet gained widespread adoption. In 2016, the American Society for Stereotactic and Functional Neurosurgery (ASSFN) convened a meeting with leaders in the field to discuss a roadmap for the path forward. A follow-up meeting in 2022 aimed to review the current state of the field and to identify critical barriers and milestones for progress. DESIGN The ASSFN convened a meeting on June 3, 2022 in Atlanta, Georgia and included leaders from the fields of neurology, neurosurgery, and psychiatry along with colleagues from industry, government, ethics, and law. The goal was to review the current state of the field, assess for advances or setbacks in the interim six years, and suggest a future path forward. The participants focused on five areas of interest: interdisciplinary engagement, regulatory pathways and trial design, disease biomarkers, ethics of psychiatric surgery, and resource allocation/prioritization. The proceedings are summarized here. CONCLUSION The field of surgical psychiatry has made significant progress since our last expert meeting. Although weakness and threats to the development of novel surgical therapies exist, the identified strengths and opportunities promise to move the field through methodically rigorous and biologically-based approaches. The experts agree that ethics, law, patient engagement, and multidisciplinary teams will be critical to any potential growth in this area.
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Affiliation(s)
- Frederick L Hitti
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Alik S Widge
- Department of Psychiatry and Behavioral Sciences, University of Minnesota-Twin Cities, Minneapolis, MN, USA
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Donald A Malone
- Department of Psychiatry, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | - Maryam M Shanechi
- Departments of Electrical and Computer Engineering and Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | - Sarah H Lisanby
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Elizabeth Ankudowich
- Division of Translational Research, National Institute of Mental Health, Bethesda, MD, USA
| | - Srinivas Chivukula
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Edward F Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Aysegul Gunduz
- Department of Biomedical Engineering and Fixel Institute for Neurological Disorders, University of Florida, Gainesville, FL, USA
| | - Clement Hamani
- Sunnybrook Research Institute, Hurvitz Brain Sciences Centre, Harquail Centre for Neuromodulation, Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Ashley Feinsinger
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Cynthia S Kubu
- Department of Neurology, Cleveland Clinic and Case Western Reserve University, School of Medicine, Cleveland, OH, USA
| | - Winston Chiong
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer A Chandler
- Faculty of Law, University of Ottawa, Ottawa, ON, USA; Affiliate Investigator, Bruyère Research Institute, Ottawa, ON, USA
| | | | | | - Robert S Raike
- Global Research Organization, Medtronic Inc. Neuromodulation, Minneapolis, MN, USA
| | - Rachel A Davis
- Departments of Psychiatry and Neurosurgery, University of Colorado Anschutz, Aurora, CO, USA
| | - Casey H Halpern
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; The Cpl Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | | | - Dejan Markovic
- Department of Electrical Engineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Sarah K Bick
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cameron C McIntyre
- Departments of Biomedical Engineering and Neurosurgery, Duke University, Durham, NC, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Brian H Kopell
- Department of Neurosurgery, Center for Neuromodulation, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jennifer A Sweet
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavior Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Nader Pouratian
- Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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8
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Chen LL, Naesström M, Halvorsen M, Fytagoridis A, Mataix-Cols D, Rück C, Crowley JJ, Pascal D. Genomics of severe and treatment-resistant obsessive-compulsive disorder treated with deep brain stimulation: a preliminary investigation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.15.23288623. [PMID: 37131580 PMCID: PMC10153313 DOI: 10.1101/2023.04.15.23288623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Individuals with severe and treatment-resistant obsessive-compulsive disorder (trOCD) represent a small but severely disabled group of patients. Since trOCD cases eligible for deep brain stimulation (DBS) probably comprise the most severe end of the OCD spectrum, we hypothesize that they may be more likely to have a strong genetic contribution to their disorder. Therefore, while the worldwide population of DBS-treated cases may be small (~300), screening these individuals with modern genomic methods may accelerate gene discovery in OCD. As such, we have begun to collect DNA from trOCD cases who qualify for DBS, and here we report results from whole exome sequencing and microarray genotyping of our first five cases. All participants had previously received DBS in the bed nucleus of stria terminalis (BNST), with two patients responding to the surgery and one showing a partial response. Our analyses focused on gene-disruptive rare variants (GDRVs; rare, predicted-deleterious single-nucleotide variants or copy number variants overlapping protein-coding genes). Three of the five cases carried a GDRV, including a missense variant in the ion transporter domain of KCNB1, a deletion at 15q11.2, and a duplication at 15q26.1. The KCNB1 variant (hg19 chr20-47991077-C-T, NM_004975.3:c.1020G>A, p.Met340Ile) causes substitution of methionine for isoleucine in the trans-membrane region of neuronal potassium voltage-gated ion channel KV2.1. This KCNB1 substitution (Met340Ile) is located in a highly constrained region of the protein where other rare missense variants have previously been associated with neurodevelopmental disorders. The patient carrying the Met340Ile variant responded to DBS, which suggests that genetic factors could potentially be predictors of treatment response in DBS for OCD. In sum, we have established a protocol for recruiting and genomically characterizing trOCD cases. Preliminary results suggest that this will be an informative strategy for finding risk genes in OCD.
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Affiliation(s)
- Long Long Chen
- Department of Clinical Neuroscience, Centre for Psychiatry Research Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Matilda Naesström
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Matthew Halvorsen
- Department of Clinical Neuroscience, Centre for Psychiatry Research Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anders Fytagoridis
- Department of Neurosurgery, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Centre for Psychiatry Research Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - James J. Crowley
- Department of Clinical Neuroscience, Centre for Psychiatry Research Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diana Pascal
- Department of Clinical Neuroscience, Centre for Psychiatry Research Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
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9
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Swierkosz-Lenart K, Dos Santos JFA, Elowe J, Clair AH, Bally JF, Riquier F, Bloch J, Draganski B, Clerc MT, Pozuelo Moyano B, von Gunten A, Mallet L. Therapies for obsessive-compulsive disorder: Current state of the art and perspectives for approaching treatment-resistant patients. Front Psychiatry 2023; 14:1065812. [PMID: 36873207 PMCID: PMC9978117 DOI: 10.3389/fpsyt.2023.1065812] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Even though obsessive compulsive disorder (OCD) is one of the ten most disabling diseases according to the WHO, only 30-40% of patients suffering from OCD seek specialized treatment. The currently available psychotherapeutic and pharmacological approaches, when properly applied, prove ineffective in about 10% of cases. The use of neuromodulation techniques, especially Deep Brain Stimulation, is highly promising for these clinical pictures and knowledge in this domain is constantly evolving. The aim of this paper is to provide a summary of the current knowledge about OCD treatment, while also discussing the more recent proposals for defining resistance.
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Affiliation(s)
- Kevin Swierkosz-Lenart
- Department of Psychiatry, Service Universitaire de Psychiatrie de l’Age Avancé (SUPAA), Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | | | - Julien Elowe
- Department of Psychiatry, Lausanne University Hospital, University of Lausanne, West Sector, Prangins, Switzerland
- Department of Psychiatry, Lausanne University Hospital, University of Lausanne, North Sector, Yverdon-les-Bains, Switzerland
| | - Anne-Hélène Clair
- Sorbonne University, UPMC Paris 06 University, INSERM, CNRS, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Julien F. Bally
- Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Françoise Riquier
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Jocelyne Bloch
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Bogdan Draganski
- Laboratory for Research in Neuroimaging (LREN), Department of Clinical Neurosciences, Centre for Research in Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Marie-Thérèse Clerc
- Department of Psychiatry, Service Universitaire de Psychiatrie de l’Age Avancé (SUPAA), Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | - Beatriz Pozuelo Moyano
- Department of Psychiatry, Service Universitaire de Psychiatrie de l’Age Avancé (SUPAA), Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | - Armin von Gunten
- Department of Psychiatry, Service Universitaire de Psychiatrie de l’Age Avancé (SUPAA), Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | - Luc Mallet
- Department of Mental Health and Psychiatry, Geneva University Hospital, Geneva, Switzerland
- Univ Paris-Est Créteil, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d’Addictologie, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
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10
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Zhao ZP, Nie C, Jiang CT, Cao SH, Tian KX, Yu S, Gu JW. Modulating Brain Activity with Invasive Brain-Computer Interface: A Narrative Review. Brain Sci 2023; 13:brainsci13010134. [PMID: 36672115 PMCID: PMC9856340 DOI: 10.3390/brainsci13010134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/17/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023] Open
Abstract
Brain-computer interface (BCI) can be used as a real-time bidirectional information gateway between the brain and machines. In particular, rapid progress in invasive BCI, propelled by recent developments in electrode materials, miniature and power-efficient electronics, and neural signal decoding technologies has attracted wide attention. In this review, we first introduce the concepts of neuronal signal decoding and encoding that are fundamental for information exchanges in BCI. Then, we review the history and recent advances in invasive BCI, particularly through studies using neural signals for controlling external devices on one hand, and modulating brain activity on the other hand. Specifically, regarding modulating brain activity, we focus on two types of techniques, applying electrical stimulation to cortical and deep brain tissues, respectively. Finally, we discuss the related ethical issues concerning the clinical application of this emerging technology.
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Affiliation(s)
- Zhi-Ping Zhao
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Chuang Nie
- Strategic Support Force Medical Center, Beijing 100101, China
| | - Cheng-Teng Jiang
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Sheng-Hao Cao
- Brainnetome Center and National Laboratory of Pattern Recognition, Chinese Academy of Sciences, Beijing 100190, China
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Kai-Xi Tian
- Brainnetome Center and National Laboratory of Pattern Recognition, Chinese Academy of Sciences, Beijing 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shan Yu
- Brainnetome Center and National Laboratory of Pattern Recognition, Chinese Academy of Sciences, Beijing 100190, China
- School of Future Technology, University of Chinese Academy of Sciences, Beijing 100049, China
- Correspondence: (S.Y.); (J.-W.G.); Tel.: +86-010-8254-4786 (S.Y.); +86-010-6635-6729 (J.-W.G.)
| | - Jian-Wen Gu
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
- Strategic Support Force Medical Center, Beijing 100101, China
- Correspondence: (S.Y.); (J.-W.G.); Tel.: +86-010-8254-4786 (S.Y.); +86-010-6635-6729 (J.-W.G.)
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11
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Visser-Vandewalle V, Andrade P, Mosley PE, Greenberg BD, Schuurman R, McLaughlin NC, Voon V, Krack P, Foote KD, Mayberg HS, Figee M, Kopell BH, Polosan M, Joyce EM, Chabardes S, Matthews K, Baldermann JC, Tyagi H, Holtzheimer PE, Bervoets C, Hamani C, Karachi C, Denys D, Zrinzo L, Blomstedt P, Naesström M, Abosch A, Rasmussen S, Coenen VA, Schlaepfer TE, Dougherty DD, Domenech P, Silburn P, Giordano J, Lozano AM, Sheth SA, Coyne T, Kuhn J, Mallet L, Nuttin B, Hariz M, Okun MS. Deep brain stimulation for obsessive-compulsive disorder: a crisis of access. Nat Med 2022; 28:1529-1532. [PMID: 35840727 DOI: 10.1038/s41591-022-01879-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - Pablo Andrade
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Philip E Mosley
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, and Queensland Brain Institute, Brisbane, Queensland, Australia
| | - Benjamin D Greenberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Center for Neuromodulation, Butler Hospital, Providence, RI, USA.,RR&D Center for Neurorestoration and Neurotechnology, Providence, RI, USA
| | - Rick Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Nicole C McLaughlin
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island, USA
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Kelly D Foote
- Department of Neurosurgery, University of Florida Health, Gainesville, FL, USA.,Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martijn Figee
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian H Kopell
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mircea Polosan
- Fondation Fondamental, Créteil, France.,Centre Expert Troubles Bipolaires, Service Universitaire de Psychiatrie, Centre Hospitalier Universitaire de Grenoble et des Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Inserm U 836, La Tronche, France
| | - Eileen M Joyce
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Stephan Chabardes
- Department of Neurosurgery, Grenoble University Hospital, Grenoble, France
| | - Keith Matthews
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Juan C Baldermann
- Department of Neurology, University Hospital Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Himanshu Tyagi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Paul E Holtzheimer
- Departments of Psychiatry and Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Chris Bervoets
- Department of Neurosciences, Adult Psychiatry, UPC KU Leuven, Leuven, Belgium
| | - Clement Hamani
- Sunnybrook Research Institute, Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Carine Karachi
- Neurosurgery Department, Hôpital de la Salpêtrière, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | | | - Matilda Naesström
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Aviva Abosch
- Department of Neurosurgery and Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Rasmussen
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.,Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Deep Brain Stimulation, Freiburg University, Freiburg, Germany
| | - Thomas E Schlaepfer
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Deep Brain Stimulation, Freiburg University, Freiburg, Germany
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA, USA
| | - Philippe Domenech
- Département Médico-Universitaire de Psychiatrie et d'Addictologie, Assistance Publique-Hôpitaux de Paris, Le Groupe Hospitalier Universitaire Henri Mondor, Université Paris-Est, Créteil, France.,Institut du Cerveau, Inserm U1127, CNRS UMR7225, Sorbonne Université, Paris, France
| | - Peter Silburn
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - James Giordano
- Department of Neurology, Georgetown University Medical Center, Washington, DC, USA.,Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, DC, USA.,Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC, USA
| | - Andres M Lozano
- Department of Neurosurgery and Neuroscience, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Terry Coyne
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.,Department of Psychiatry, Psychotherapy, and Psychosomatics, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | - Luc Mallet
- Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, University Paris-Est Créteil, Créteil, France.,Institut du Cerveau, Paris Brain Institute, Inserm, CNRS, Sorbonne Université, Paris, France.,Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Bart Nuttin
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marwan Hariz
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Unit for Deep Brain Stimulation, Umeå University, Umeå, Sweden
| | - Michael S Okun
- Department of Neurosurgery, University of Florida Health, Gainesville, FL, USA.,Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA.,Department of Neurology, University of Florida Health, Gainesville, FL, USA
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12
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Mitchell KT, Schmidt SL, Cooney JW, Grill WM, Peters J, Rahimpour S, Lee HJ, Jung SH, Mantri S, Scott B, Lad SP, Turner DA. Initial Clinical Outcome With Bilateral, Dual-Target Deep Brain Stimulation Trial in Parkinson Disease Using Summit RC + S. Neurosurgery 2022; 91:132-138. [PMID: 35383660 PMCID: PMC9514741 DOI: 10.1227/neu.0000000000001957] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/16/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is an effective therapy in advanced Parkinson disease (PD). Although both subthalamic nucleus (STN) and globus pallidus (GP) DBS show equivalent efficacy in PD, combined stimulation may demonstrate synergism. OBJECTIVE To evaluate the clinical benefit of stimulating a combination of STN and GP DBS leads and to demonstrate biomarker discovery for adaptive DBS therapy in an observational study. METHODS We performed a pilot trial (n = 3) of implanting bilateral STN and GP DBS leads, connected to a bidirectional implantable pulse generator (Medtronic Summit RC + S; NCT03815656, IDE No. G180280). Initial 1-year outcome in 3 patients included Unified PD Rating Scale on and off medications, medication dosage, Hauser diary, and recorded beta frequency spectral power. RESULTS Combined DBS improved PD symptom control, allowing >80% levodopa medication reduction. There was a greater decrease in off-medication motor Unified PD Rating Scale with multiple electrodes activated (mean difference from off stimulation off medications -18.2, range -25.5 to -12.5) than either STN (-12.8, range -20.5 to 0) or GP alone (-9, range -11.5 to -4.5). Combined DBS resulted in a greater reduction of beta oscillations in STN in 5/6 hemispheres than either site alone. Adverse events occurred in 2 patients, including a small cortical hemorrhage and seizure at 24 hours postoperatively, which resolved spontaneously, and extension wire scarring requiring revision at 2 months postoperatively. CONCLUSION Patients with PD preferred combined DBS stimulation in this preliminary cohort. Future studies will address efficacy of adaptive DBS as we further define biomarkers and control policy.
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Affiliation(s)
- Kyle T. Mitchell
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Stephen L. Schmidt
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Jeffrey W. Cooney
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Warren M. Grill
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer Peters
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, Utah, USA;
| | - Hui-Jie Lee
- Duke University CTSI Biostatistics, Epidemiology and Research Design, Durham, North Carolina, USA
| | - Sin-Ho Jung
- Duke University CTSI Biostatistics, Epidemiology and Research Design, Durham, North Carolina, USA
| | - Sneha Mantri
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Burton Scott
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Shivanand P. Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Dennis A. Turner
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA
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13
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Stevens I, Gilbert F. International Regulatory Standards for the Qualitative Measurement of Deep Brain Stimulation in Clinical Research. J Empir Res Hum Res Ethics 2022; 17:228-241. [DOI: 10.1177/15562646221094922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Deep brain stimulation (DBS) has progressed to become a promising treatment modality for neurologic and psychiatric disorders like epilepsy and major depressive disorder due to its growing personalization. Despite evidence pointing to the benefits of DBS if tested on these personalized qualitative metrics, rather than randomized-control trial quantitative standards, the evaluation of these novel devices appears to be based on the latter. This study surveyed the presence of this trend in the national regulatory guidelines of the prominent DBS researching countries. It was found that two governing bodies, in the European Union and Australia, acknowledged the option for qualitative measures. These findings support further development of national regulatory guidelines, so the neuroscientific community developing these neurotechnologies can better understand the impact their treatments have on patients.
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Affiliation(s)
- I. Stevens
- School of Humanities, University of Tasmania, Hobart, Tasmania, Australia
| | - F. Gilbert
- School of Humanities, University of Tasmania, Hobart, Tasmania, Australia
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14
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Mar-Barrutia L, Real E, Segalás C, Bertolín S, Menchón JM, Alonso P. Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years. World J Psychiatry 2021; 11:659-680. [PMID: 34631467 PMCID: PMC8474989 DOI: 10.5498/wjp.v11.i9.659] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/02/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Twenty years after its first use in a patient with obsessive-compulsive disorder (OCD), the results confirm that deep brain stimulation (DBS) is a promising therapy for patients with severe and resistant forms of the disorder. Nevertheless, many unknowns remain, including the optimal anatomical targets, the best stimulation parameters, the long-term (LT) effects of the therapy, and the clinical or biological factors associated with response. This systematic review of the articles published to date on DBS for OCD assesses the short and LT efficacy of the therapy and seeks to identify predictors of response.
AIM To summarize the existing knowledge on the efficacy and tolerability of DBS in treatment-resistant OCD.
METHODS A comprehensive search was conducted in the PubMed, Cochrane, Scopus, and ClinicalTrials.gov databases from inception to December 31, 2020, using the following strategy: “(Obsessive-compulsive disorder OR OCD) AND (deep brain stimulation OR DBS).” Clinical trials and observational studies published in English and evaluating the effectiveness of DBS for OCD in humans were included and screened for relevant information using a standardized collection tool. The inclusion criteria were as follows: a main diagnosis of OCD, DBS conducted for therapeutic purposes and variation in symptoms of OCD measured by the Yale-Brown Obsessive-Compulsive scale (Y-BOCS) as primary outcome. Data were analyzed with descriptive statistics.
RESULTS Forty articles identified by the search strategy met the eligibility criteria. Applying a follow-up threshold of 36 mo, 29 studies (with 230 patients) provided information on short-term (ST) response to DBS in, while 11 (with 155 patients) reported results on LT response. Mean follow-up period was 18.5 ± 8.0 mo for the ST studies and 63.7 ± 20.7 mo for the LT studies. Overall, the percentage of reduction in Y-BOCS scores was similar in ST (47.4%) and LT responses (47.2%) to DBS, but more patients in the LT reports met the criteria for response (defined as a reduction in Y-BOCS scores > 35%: ST, 60.6% vs LT, 70.7%). According to the results, the response in the first year predicts the extent to which an OCD patient will benefit from DBS, since the maximum symptom reduction was achieved in most responders in the first 12-14 mo after implantation. Reports indicate a consistent tendency for this early improvement to be maintained to the mid-term for most patients; but it is still controversial whether this improvement persists, increases or decreases in the long term. Three different patterns of LT response emerged from the analysis: 49.5% of patients had good and sustained response to DBS, 26.6% were non responders, and 22.5% were partial responders, who might improve at some point but experience relapses during follow-up. A significant improvement in depressive symptoms and global functionality was observed in most studies, usually (although not always) in parallel with an improvement in obsessive symptoms. Most adverse effects of DBS were mild and transient and improved after adjusting stimulation parameters; however, some severe adverse events including intracranial hemorrhages and infections were also described. Hypomania was the most frequently reported psychiatric side effect. The relationship between DBS and suicide risk is still controversial and requires further study. Finally, to date, no clear clinical or biological predictors of response can be established, probably because of the differences between studies in terms of the neuroanatomical targets and stimulation protocols assessed.
CONCLUSION The present review confirms that DBS is a promising therapy for patients with severe resistant OCD, providing both ST and LT evidence of efficacy.
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Affiliation(s)
- Lorea Mar-Barrutia
- OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona 08907, Spain
| | - Eva Real
- OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona 08907, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, Barcelona 08907, Spain
- CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Madrid 28029, Spain
| | - Cinto Segalás
- OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona 08907, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, Barcelona 08907, Spain
- CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Madrid 28029, Spain
| | - Sara Bertolín
- OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona 08907, Spain
| | - José Manuel Menchón
- OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona 08907, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, Barcelona 08907, Spain
- CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Madrid 28029, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona 08907, Spain
| | - Pino Alonso
- OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona 08907, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, Barcelona 08907, Spain
- CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Madrid 28029, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona 08907, Spain
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15
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Polosan M, Figee M. Electrical deep neuromodulation in psychiatry. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 159:89-110. [PMID: 34446252 DOI: 10.1016/bs.irn.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Addressing treatment refractoriness in psychiatric diseases is an essential public health objective. The last two decades have seen an increasing interest for deep brain stimulation (DBS) of several brain targets. In this chapter, we have reviewed the main DBS clinical trials in psychiatric diseases, mainly obsessive compulsive disorders (OCD) and depression, but also emerging research in other psychiatric disorders. While its efficacy and safety are confirmed, DBS is still not considered as standard therapy in psychiatry. However, advances in neuroimaging research combined to behavioral and electrophysiological data uniquely provided by DBS studies improve knowledge on physiopathology in these brain diseases. This will help define the optimal brain targets according to specific phenotype dimensions. Revealing the mechanisms of action and effects of DBS will support that its impact goes beyond a loco-regional brain stimulation and confirms that electrical neuromodulation influences brain networks. Added to the progress in neuromodulation technology, these insights will hopefully facilitate a more widespread application of this promising treatment. Future development of a personalized multimodal assessment of underlying dysfunctional brain networks will open new circuit-specific treatment perspectives that may facilitate better patient outcomes.
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Affiliation(s)
- Mircea Polosan
- Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.
| | - Martijn Figee
- Center for Advanced Circuit Therapeutics, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, United States
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16
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Xiong B, Wen R, Gao Y, Wang W. Longitudinal Changes of Local Field Potential Oscillations in Nucleus Accumbens and Anterior Limb of the Internal Capsule in Obsessive-Compulsive Disorder. Biol Psychiatry 2021; 93:e39-e41. [PMID: 34303518 DOI: 10.1016/j.biopsych.2021.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Botao Xiong
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Wen
- Department of Neurosurgery, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuan Gao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
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17
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Arumugham SS, Srinivas D, Narayanaswamy JC, Jaisoorya TS, Kashyap H, Domenech P, Palfi S, Mallet L, Venkatasubramanian G, Reddy YJ. Identification of biomarkers that predict response to subthalamic nucleus deep brain stimulation in resistant obsessive-compulsive disorder: protocol for an open-label follow-up study. BMJ Open 2021; 11:e047492. [PMID: 34158304 PMCID: PMC8220486 DOI: 10.1136/bmjopen-2020-047492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/26/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) of bilateral anteromedial subthalamic nucleus (amSTN) has been found to be helpful in a subset of patients with severe, chronic and treatment-refractory obsessive-compulsive disorder (OCD). Biomarkers may aid in patient selection and optimisation of this invasive treatment. In this trial, we intend to evaluate neurocognitive function related to STN and related biosignatures as potential biomarkers for STN DBS in OCD. METHODS AND ANALYSIS Twenty-four subjects with treatment-refractory OCD will undergo open-label STN DBS. Structural/functional imaging, electrophysiological recording and neurocognitive assessment would be performed at baseline. The subjects would undergo a structured clinical assessment for 12 months postsurgery. A group of 24 healthy volunteers and 24 subjects with treatment-refractory OCD who receive treatment as usual would be recruited for comparison of biomarkers and treatment response, respectively. Baseline biomarkers would be evaluated as predictors of clinical response. Neuroadaptive changes would be studied through a reassessment of neurocognitive functioning, imaging and electrophysiological activity post DBS. ETHICS AND DISSEMINATION The protocol has been approved by the National Institute of Mental Health and Neurosciences Ethics Committee. The study findings will be disseminated through peer-reviewed scientific journals and scientific meetings.
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Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - T S Jaisoorya
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Himani Kashyap
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Philippe Domenech
- Univ Paris-Est Créteil, DMU CARE - Département Médical-Universitaire de Chirurgie et Anesthésie réanimation, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
- Univ of Paris 12 UPEC, Faculté de médecine, INSERM U955, Creteil, France
| | - Stéphane Palfi
- Univ Paris-Est Créteil, DMU CARE - Département Médical-Universitaire de Chirurgie et Anesthésie réanimation, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
- Univ of Paris 12 UPEC, Faculté de médecine, INSERM U955, Creteil, France
| | - Luc Mallet
- Institut du Cerveau, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Yc Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Pinckard-Dover H, Ward H, Foote KD. The Decline of Deep Brain Stimulation for Obsessive-Compulsive Disorder Following FDA Humanitarian Device Exemption Approval. Front Surg 2021; 8:642503. [PMID: 33777998 PMCID: PMC7994854 DOI: 10.3389/fsurg.2021.642503] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/10/2021] [Indexed: 12/21/2022] Open
Abstract
Background: In February 2009, the US Food and Drug Administration (FDA) granted Humanitarian Device Exemption (HDE) for deep brain stimulation (DBS) in the anterior limb of the internal capsule (ALIC) for the treatment of severely debilitating, treatment refractory obsessive–compulsive disorder (OCD). Despite its promise as a life altering treatment for patients with otherwise refractory, severely debilitating OCD, the use of DBS for the treatment of OCD has diminished since the FDA HDE endorsement and is now rarely performed even at busy referral centers. We sought to identify factors hindering OCD patients from receiving DBS therapy. Materials and Methods: University of Florida (UF) clinical research databases were queried to identify patients evaluated as potential candidates for OCD DBS from January 1, 2002 to July 30, 2020. A retrospective review of these patients' medical records was performed to obtain demographic information, data related to their OCD, and details relevant to payment such as third-party payer, study participation, evaluation prior to or after HDE approval, and any stated factors prohibiting surgical intervention. Results: Out of 25 patients with severe OCD identified as candidates for DBS surgery during the past 18 years, 15 underwent surgery. Prior to FDA HDE approval, 6 out of 7 identified candidates were treated. After the HDE, only 9 out of 18 identified candidates were treated. Seven of the 9 were funded by Medicare, 1 paid out of pocket, and 1 had “pre-authorization” from her private insurer who ultimately refused to pay after the procedure. Among the 10 identified OCD DBS candidates who were ultimately not treated, 7 patients—all with private health insurance—were approved for surgery by the interdisciplinary team but were unable to proceed with surgery due to lack of insurance coverage, 1 decided against surgical intervention, 1 was excluded due to medical comorbidities and excessive perceived surgical risk, and no clear reason was identified for 1 patient evaluated in 2004 during our initial NIH OCD DBS trial. Conclusion: Based on compelling evidence that DBS provides substantial improvement of OCD symptoms and markedly improved functional capacity in 2 out of 3 patients with severely debilitating, treatment refractory OCD, the FDA approved this procedure under a Humanitarian Device Exemption in 2009, offering new hope to this unfortunate patient population. A careful review of our experience with OCD DBS at the University of Florida shows that since the HDE approval, only 50% of the severe OCD patients (9 of 18) identified as candidates for this potentially life altering treatment have been able to access the therapy. We found the most common limiting factor to be failure of private insurance policies to cover DBS for OCD, despite readily covering DBS for Parkinson's disease, essential tremor, and even dystonia—another HDE approved indication for DBS. We have identified an inherent discrimination in the US healthcare system against patients with medication-refractory OCD who are economically challenged and do not qualify for Medicare. We urge policy makers, insurance companies, and hospital administrations to recognize this health care disparity and seek to rectify it.
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Affiliation(s)
- Heather Pinckard-Dover
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States.,Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
| | - Herbert Ward
- Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States.,Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Kelly D Foote
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States.,Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, United States
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