Deep brain stimulation for obsessive-compulsive disorder: Using functional magnetic resonance imaging and electrophysiological techniques: Technical case report
Deep brain stimulation for obsessive-compulsive disorder: Using functional magnetic resonance imaging and electrophysiological techniques: Technical case report
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DOI：
10.1227/01.neu.0000303995.66902.36
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发表时间：
2007-11-01
期刊：
影响因子：
4.8
通讯作者：
Rezai, Ali R.
中科院分区：
文献类型：
--
作者：
Baker, Kenneth B.;Kopell, Brian H.;Rezai, Ali R.
目标和重要性：为了证明与电刺激相关的激活模式，通过放置在内囊前肢内的双侧脑深部刺激电极到腹侧纹状体水平，用于治疗强迫症。临床表现：一名有26年强迫症病史的44岁男性接受了功能性磁共振成像（fMRI）和脑深部电刺激-双侧植入脑深部电刺激电极导线后的皮层诱发电位测试。使用外部脉冲发生器，通过每根经皮延长电极导线的远端两个触点独立地双侧输送刺激。我们使用3特斯拉磁共振系统来测量术后第2天fMRI血氧水平依赖信号的变化。变化与预先确定的刺激参数进行比较，以证明行为effects.INTERVENTION：所有研究都耐受良好。术中以及术后第I天进行的试验刺激与情绪急性升高和焦虑减少相关。尽管双侧电极导线之间即刻获得的受益相对对称，但随访程控显示出明显优于右侧刺激。四个fMRI试验中的三个表现出良好的激活，第四个被运动伪影中度破坏。右侧刺激观察到的有益效果与同侧尾状核头、内侧丘脑和前扣带回皮质以及对侧小脑的激活相关。皮层诱发电位的分布与fMRI观察到的皮层激活位点一致。结论：通过放置在内囊前肢的导线进行高频刺激，可在皮层和皮层下水平引起广泛的血流动力学变化，包括与强迫症发病机制相关的区域。
OBJECTIVE AND IMPORTANCE: To demonstrate the pattern of activation associated with electrical stimulation through bilateral deep brain stimulation electrodes placed within the anterior limb of the internal capsule to the level of the ventral striatum for treatment of obsessive-compulsive disorder.CLINICAL PRESENTATION: A 44-year-old man with a 26-year history of obsessive-compulsive disorder underwent functional magnetic resonance imaging (fMRI) and deep brain stimulation-evoked cortical potential testing after bilateral implantation of deep brain stimulation leads. Stimulation was delivered bilaterally independently through the distal two contacts of each percutaneously extended lead using an external pulse generator. We used a 3-Tesla magnetic resonance system to measure changes in the fMRI blood oxygen level-dependent signal on postoperative Day 2. Changes were compared with stimulation parameters that were predetermined to demonstrate behavioral effects.INTERVENTION: All studies were well tolerated. Trial stimulations performed intraoperatively as well as on post-surgical Day I were associated with acutely elevated mood and reduced anxiety. Although the benefit achieved acutely was relatively symmetric between the bilaterally placed leads, follow-up programming showed a clear advantage to right-sided stimulation. Three of the four fMRI trials demonstrated good activation, with the fourth being moderately corrupted by motion artifact. The beneficial effects observed with right-sided stimulation were associated with activation of the ipsilateral head of the caudate, medial thalamus, and anterior cingulate cortex as well as the contralateral cerebellum. The distribution of the cortical evoked potentials was consistent with the locus of cortical activation observed with fMRI.CONCLUSION: High-frequency stimulation via a lead placed in the anterior limb of the internal capsule induced widespread hemodynamic changes at both the cortical and subcortical levels including areas typically associated with the pathogenesis of obsessive-compulsive disorder.