PDF(Pubmed)
Abstract：
UNASSIGNED: Deep brain stimulation (DBS) of the anterior limb of the internal capsule (ALIC) is an emerging treatment for severe, refractory obsessive-compulsive disorder (OCD). The therapeutic effects of DBS are hypothesized to be mediated by direct modulation of a distributed cortico-striato-thalmo-cortical network underlying OCD symptoms. However, the exact underlying mechanism by which DBS exerts its therapeutic effects still remains unclear.
UNASSIGNED: In five participants receiving DBS for severe, refractory OCD (3 responders, 2 non-responders), we conducted a DBS On/Off cycling paradigm during the acquisition of functional MRI to determine the network effects of stimulation across a variety of bipolar configurations. We also performed tractography using diffusion-weighted imaging (DWI) to relate the functional impact of DBS to the underlying structural connectivity between active stimulation contacts and functional brain networks.
UNASSIGNED: We found that therapeutic DBS had a distributed effect, suppressing BOLD activity within regions such as the orbitofrontal cortex, dorsomedial prefrontal cortex, and subthalamic nuclei compared to non-therapeutic configurations. Many of the regions suppressed by therapeutic DBS were components of the default mode network (DMN). Moreover, the estimated stimulation field from the therapeutic configurations exhibited significant structural connectivity to core nodes of the DMN.
UNASSIGNED: Therapeutic DBS for OCD suppresses BOLD activity within a distributed set of regions within the DMN relative to non-therapeutic configurations. We propose that these effects may be mediated by interruption of communication through structural white matter connections surrounding the DBS active contacts.
UNASSIGNED: In five participants receiving DBS for severe, refractory OCD (3 responders, 2 non-responders), we conducted a DBS On/Off cycling paradigm during the acquisition of functional MRI to determine the network effects of stimulation across a variety of bipolar configurations. We also performed tractography using diffusion-weighted imaging (DWI) to relate the functional impact of DBS to the underlying structural connectivity between active stimulation contacts and functional brain networks.
UNASSIGNED: We found that therapeutic DBS had a distributed effect, suppressing BOLD activity within regions such as the orbitofrontal cortex, dorsomedial prefrontal cortex, and subthalamic nuclei compared to non-therapeutic configurations. Many of the regions suppressed by therapeutic DBS were components of the default mode network (DMN). Moreover, the estimated stimulation field from the therapeutic configurations exhibited significant structural connectivity to core nodes of the DMN.
UNASSIGNED: Therapeutic DBS for OCD suppresses BOLD activity within a distributed set of regions within the DMN relative to non-therapeutic configurations. We propose that these effects may be mediated by interruption of communication through structural white matter connections surrounding the DBS active contacts.
摘要：
背景：内囊前肢（ALIC）的深部脑刺激（DBS）是一种新兴的治疗方法，难治性强迫症（OCD）。假设DBS的治疗效果是由OCD症状背后的分布式皮质-纹状体-丘脑-皮层网络的直接调节介导的。然而,DBS发挥其治疗作用的确切潜在机制仍不清楚.
方法：在接受严重DBS的五名参与者中，难治性强迫症(3名响应者，2个无响应者)，我们在获取功能性MRI时进行了DBS开/关循环模式,以确定刺激在各种双极构型中的网络效应.我们还使用扩散加权成像（DWI）进行了纤维束成像，以将DBS的功能影响与主动刺激接触和功能性大脑网络之间的潜在结构连通性联系起来。
结果：我们发现治疗性DBS具有分布效应，抑制诸如眶额皮质等区域的BOLD活动，背内侧前额叶皮质,和丘脑底核与非治疗构型相比。由治疗性DBS抑制的许多区域是默认模式网络(DMN)的组件。此外，来自治疗配置的估计刺激场表现出与DMN核心节点的显著结构连通性。
结论：用于OCD的治疗性DBS相对于非治疗性构型在DMN内的一组分布区域内抑制BOLD活性。我们建议这些影响可能是通过DBS有源触点周围的结构性白质连接中断通信来介导的。
方法：在接受严重DBS的五名参与者中，难治性强迫症(3名响应者，2个无响应者)，我们在获取功能性MRI时进行了DBS开/关循环模式,以确定刺激在各种双极构型中的网络效应.我们还使用扩散加权成像（DWI）进行了纤维束成像，以将DBS的功能影响与主动刺激接触和功能性大脑网络之间的潜在结构连通性联系起来。
结果：我们发现治疗性DBS具有分布效应，抑制诸如眶额皮质等区域的BOLD活动，背内侧前额叶皮质,和丘脑底核与非治疗构型相比。由治疗性DBS抑制的许多区域是默认模式网络(DMN)的组件。此外，来自治疗配置的估计刺激场表现出与DMN核心节点的显著结构连通性。
结论：用于OCD的治疗性DBS相对于非治疗性构型在DMN内的一组分布区域内抑制BOLD活性。我们建议这些影响可能是通过DBS有源触点周围的结构性白质连接中断通信来介导的。
