Target-specific deep brain stimulation of the ventral capsule/ventral striatum for the treatment of neuropsychiatric disease

Abstract

Deep brain stimulation (DBS) is a well-established therapy for Parkinson's disease and other movement disorders. An accumulating body of evidence supports the extension of DBS application for the treatment of refractory psychiatric disorders. The ventral capsule/ventral striatum (VC/VS) is the most common anatomical target for obsessive-compulsive disorder (OCD), addiction, and depression. However, no specific electrode is available for the clinical targeting of these areas for DBS. According to the anatomical features of the VC/VS, a novel electrode was developed for simultaneous and independently programmed stimulation of the nucleus accumbens (NAc) and the anterior limb of the internal capsule (ALIC). This VC/VS-specific electrode has the potential to enhance stimulus intensity, provide independent and flexible target stimulation.

Update on Current Technologies for Deep Brain Stimulation in Parkinson’s Disease

“…The currently available electrode models contain four contacts of 1.5 mm in length and are separated from one another by 0.5, 1.0, or 1.5 mm intervals. SceneRay has also designed an electrode to specifically to target the nucleus accumbens and anterior limb of the internal capsule [ 58 ]. The lead has four contacts of 3.0 mm in length; the two ventral-most contacts are separated by 2 mm, and the more dorsal contacts are separated by 4 mm.…”

High Frequency Deep Brain Stimulation of Superior Cerebellar Peduncles in a Patient with Cerebral Palsy

“…In a previous report, [ 16 ] a 3387 lead (Medtronic, 1.5 mm contacts) was used and a very high stimulation (8.0 V, 150 µs, 200 Hz) was needed to achieve any clinical effect. Here, we selected an electrode with four longer lead contacts (3 mm), which may result in a much larger stimulation area and allow stimulation at increasing intensity and density [ 22 ]. In addition, our contacts on the SCP were near the midbrain, and electrodes were positioned across both the SCP and DN to allow optimal target programming.…”

Deep brain stimulation for psychiatric disorders: From focal brain targets to cognitive networks

“…DBS was proposed as a reversible approach that would achieve the benefits of a lesion. This target, the Ventral Capsule/Ventral Striatum (VC/VS), is part of the cortico-striato-thalamo-cortical (CSTC) loop circuitry that is hypothesized to be the basis of OCD symptoms ( Zhang et al 2017 , Dougherty et al 2018 ). An additional target was identified through DBS research in PD, where OCD symptoms were decreased for an individual when given subthalamic nucleus (STN) stimulation ( Fontaine et al 2004 ).…”