Mechanisms of deep brain stimulation for obsessive compulsive disorder: effects upon cells and circuits.
Mechanisms of deep brain stimulation for obsessive compulsive disorder: effects upon cells and circuits.
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DOI：
10.3389/fnint.2012.00029
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发表时间：
2012
影响因子：
3.5
通讯作者：
Eskandar EN
中科院分区：
文献类型：
--
作者：
Bourne SK;Eckhardt CA;Sheth SA;Eskandar EN
深部脑刺激 (DBS) 已成为治疗多种运动障碍的一种安全、有效且可逆的治疗方法。这促使人们对其在包括精神疾病在内的其他应用中的使用进行了调查。近年来，DBS 被引入用于治疗强迫症 (OCD)，其特点是反复出现不想要的想法或想法（强迫观念）以及为了缓解这些强迫观念（强迫行为）而进行的重复行为或精神活动。皮质-纹状体-丘脑-皮质 (CSTC) 回路（包括眶额皮质 (OFC)、前扣带皮层 (ACC)、腹侧纹状体和背内侧 (MD) 丘脑）的异常活动与强迫症有关。为此，许多 DBS 靶点包括内囊前肢 (ALIC)、腹侧囊/腹侧纹状体 (VC/VS)、腹侧尾状核、丘脑底核 (STN) 和伏隔核 (NAc) 已被研究用于治疗 OCD。尽管 DBS 在运动障碍方面具有功效并广泛使用，但其机制尚未完全了解，尤其是与精神障碍有关。虽然最初认为 DBS 会产生类似于消融手术的功能性损伤，但越来越清楚的是，DBS 可能通过激活跨越 CSTC 回路的轴突纤维、改变该网络内的振荡活动和/或释放关键神经递质来带来临床益处。在这篇文章中，我们回顾了使用 DBS 治疗强迫症如何帮助我们理解 DBS 的机制和强迫症的电路。我们回顾了 DBS 治疗强迫症的文献，并讨论了神经元水平以及更广泛的回路水平的潜在作用机制。
Deep brain stimulation (DBS) has emerged as a safe, effective, and reversible treatment for a number of movement disorders. This has prompted investigation of its use for other applications including psychiatric disorders. In recent years, DBS has been introduced for the treatment of obsessive compulsive disorder (OCD), which is characterized by recurrent unwanted thoughts or ideas (obsessions) and repetitive behaviors or mental acts performed in order to relieve these obsessions (compulsions). Abnormal activity in cortico-striato-thalamo-cortical (CSTC) circuits including the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), ventral striatum, and mediodorsal (MD) thalamus has been implicated in OCD. To this end a number of DBS targets including the anterior limb of the internal capsule (ALIC), ventral capsule/ventral striatum (VC/VS), ventral caudate nucleus, subthalamic nucleus (STN), and nucleus accumbens (NAc) have been investigated for the treatment of OCD. Despite its efficacy and widespread use in movement disorders, the mechanism of DBS is not fully understood, especially as it relates to psychiatric disorders. While initially thought to create a functional lesion akin to ablative procedures, it is increasingly clear that DBS may induce clinical benefit through activation of axonal fibers spanning the CSTC circuits, alteration of oscillatory activity within this network, and/or release of critical neurotransmitters. In this article we review how the use of DBS for OCD informs our understanding of both the mechanisms of DBS and the circuitry of OCD. We review the literature on DBS for OCD and discuss potential mechanisms of action at the neuronal level as well as the broader circuit level.