Inferior thalamic peduncle deep brain stimulation for treatment-refractory obsessive-compulsive disorder: A phase 1 pilot trial

Lee, Darrin J.; Dallapiazza, Robert F.; Vloo, Philippe De; Elias, Gavin J B; Fomenko, Anton; Boutet, Alexandre; Giacobbe, Peter; Lozano, Andrés M.

doi:10.1016/j.brs.2018.11.012

Cited by 47 publications

(36 citation statements)

References 40 publications

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“…Treatment of severe cases by deep brain stimulation (DBS) to the ALIC has been approved by the FDA (Humanitarian Device Exemption) in 2009 2 . A variety of other targets have been proposed, however, including the STN 3,4 , the NAcc 5-7 , ventral capsule/ventral striatum (VC/VS) 8 , inferior thalamic peduncle (ITP) 9,10 , bed nucleus of the stria terminalis (BNST) 11 , anteromedial globus pallidus interna (amGPi) 12 , superolateral branch of the medial forebrain bundle (slMFB) 13 and medial dorsal and ventral anterior nuclei of the thalamus (MD/vANT) 14 (for an overview of targets see 15 ). A recent prospective clinical trial implanted four electrodes per patient with one pair in the STN and one in the ALIC 16 .…”

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confidence: 99%

Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Baldermann

Kibleur

et al. 2019

Preprint

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Multiple surgical targets have been proposed for treating obsessive-compulsive disorder (OCD) with deep brain stimulation (DBS). However, different targets may modulate the same neural network responsible for clinical improvement. Here we analyzed data from four cohorts of OCD patients (N = 50) that underwent DBS to the anterior limb of the internal capsule (ALIC), the nucleus accumbens (NAcc) or the subthalamic nucleus (STN). Fiber tracts that were predominantly connected to electrodes in good or poor DBS responders were isolated from a normative structural connectome and assigned a predictive value. Strikingly, the same fiber bundle was related to treatment response when independently analyzing two large training cohorts that targeted either ALIC or STN. This discriminative tract is a subsection of the ALIC and connects frontal regions (such as the dorsal anterior cingulate, dACC, and ventral prefrontal, vlPFC, cortices to the STN). When informing the tract solely based on one cohort (e.g. ALIC), clinical improvements in the other (e.g. STN)could be significantly predicted, and vice versa. Finally, clinical improvements of eight patients from a third center with electrodes in the NAcc and six patients from a fourth center in which electrodes had been implanted in both STN and ALIC were significantly predicted based on this novel tract-based DBS target. Results suggest a functional role of a limbic hyperdirect pathway that projects from dACC and vlPFC to anteriomedial STN. Obsessivecompulsive symptoms seem to be tractable by modulating the specific bundle isolated here.Our results show that connectivity-derived improvement models can inform clinical improvement across DBS targets, surgeons and centers. The identified tract is now threedimensionally defined in stereotactic standard space and will be made openly available.

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confidence: 99%

Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Baldermann

Kibleur

et al. 2019

Preprint

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“…Following informed consent to surgery, the patient underwent inferior thalamic peduncle (ITP) DBS as previously described [16]. First, a T1-weighted three-dimensional spoiled gradient echo (3D-SPGR) MRI scan (General Electric Signa Excite 1.5T scanner, voxel size 1 Â 1 Â 1 mm, TR 12.4 ms, TE 5.3 ms, flip angle 20 ) was acquired for stereotactic planning.…”

Section: Clinical Case Reportmentioning

confidence: 99%

Probing the circuitry of panic with deep brain stimulation: Connectomic analysis and review of the literature

et al. 2020

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Background: Panic attacks affect a sizeable proportion of the population. The neurocircuitry of panic remains incompletely understood. Objective: To investigate the neuroanatomical underpinnings of panic attacks induced by deep brain stimulation (DBS) through (1) connectomic analysis of an obsessive-compulsive disorder patient who experienced panic attacks during inferior thalamic peduncle DBS; (2) appraisal of existing clinical reports on DBS-induced panic attacks. Methods: Panicogenic, ventral contact stimulation was compared with benign stimulation at other contacts using volume of tissue activated (VTA) modelling. Networks associated with the panicogenic zone were investigated using state-of-the-art normative connectivity mapping. In addition, a literature search for prior reports of DBS-induced panic attacks was conducted. Results: Panicogenic VTAs impinged primarily on the tuberal hypothalamus. Compared to nonpanicogenic VTAs, panicogenic loci were significantly functionally coupled to limbic and brainstem structures, including periaqueductal grey and amygdala. Previous studies found stimulation of these areas can also provoke panic attacks. Conclusions: DBS in the region of the tuberal hypothalamus elicited panic attacks in a single obsessivecompulsive disorder patient and recruited a network of structures previously implicated in panic pathophysiology, reinforcing the importance of the hypothalamus as a hub of panicogenic circuitry.

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“…Jimenez et al (14) were the first to report a six-patient case series of ITP-DBS for OCD: all patients were responders and a 51% improvement in Y-BOCS scores at 1 year was found (14). Lee et al (15) later reported a five-patient case series of ITP-DBS for OCD: all patients were responders with 52% improvement in Y-BOCS at 1 year. FDG-PET imaging in two patients revealed a decreased metabolic level in the caudate, the putamen, and the cingulum after 3 months of ITP-DBS, similar to that observed with SSRIs (113).…”

Section: Inferior Thalamic Pedunclementioning

confidence: 99%

“…A network, including cognitive and limbic territories of basal ganglia nuclei [ventral striatum (VS) (9), nucleus accumbens (NAcc) (10), and anteromedial subthalamic nucleus (amSTN) (11,12)] and white matter bundles [anterior limb of the internal capsule (ALIC) (13), ventral capsule (VC), and inferior thalamic peduncle (ITP) (14,15)] connecting frontal areas to basal ganglia has been proposed to be at the core of OCD physiopathology (16). Such a fronto-striato-thalamo-cortical network has been found to be altered in neuroimaging (17) and anatomical connectivity studies in OCD (18).…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder: Towards an Individualized Approach

et al. 2019

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Inferior thalamic peduncle deep brain stimulation for treatment-refractory obsessive-compulsive disorder: A phase 1 pilot trial

Cited by 47 publications

References 40 publications

Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Probing the circuitry of panic with deep brain stimulation: Connectomic analysis and review of the literature

Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder: Towards an Individualized Approach

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