重度抑郁症(MD)和强迫症(OCD)是精神疾病,对个体幸福感有巨大影响。尽管采用了最佳的治疗方案,但仍有一组患者仍然具有抗药性和立体定向手术(立体定向病变手术,SLS或深部脑刺激,DBS)可能是一种选择。最近的研究描述了与MD和OCD相关的四个网络(影响,奖励,认知控制,默认网络),但仅在皮层和相邻的皮层下级别上。尽管比较神经解剖学的巨大影响,动物科学和立体定向方法皮层下和皮层网络相互作用的整体理论难以捉摸。由于大脑皮层的主要等级等级,皮质fuggal方法已用于识别皮质下解剖结构中的连接,而没有解剖先验,部分结果令人困惑。我们在这里通过识别皮层下网络并搜索新皮层融合,从而遵循系统发育和个体发育网络发展的原理,提出了一种不同的皮层融合方法。
这项工作使用了来自规范队列的扩散张量成像数据(HumanConnectomeProject,HCP;n=200)来描述来自丘脑底核(STN)的八个皮质下纤维投射途径(PPs),黑质(SNR),红核(RN),腹侧被盖区(VTA),腹外侧丘脑(VLT)和中背丘脑(MDT)处于规范空间(MNI)。描述了皮层下和皮层融合,包括将特定途径分配给MD/OCD相关网络。模拟了不同立体定向刺激部位和程序的激活组织体积,以了解不同网络的作用。关于强迫症和MD的症状和治疗。
八个皮质下PP的详细课程(stnPP,snrPP,rnPP,vlATR,vlATRc,mdATR,mdATRc,vtaPP/slMFB)及其皮层下和皮层下的融合。内囊的前肢可以根据腹侧-背侧和中外侧梯度的网络发生进行细分。对OCD和MD的立体定向程序的模拟显示,mdATR/mdATRc(影响网络)和vtaPP/slMFB(奖励网络)占主导地位。
用于在没有解剖先验的情况下评估立体定向方法的皮质fugal搜索策略通常会导致混淆的结果,从而无法将程序明确分配给相关网络。根据我们对强迫症和MD治疗中的立体定向程序的模拟,大多数目标区域直接涉及奖励(和影响)网络,而副作用可以部分用控制网络的协同调制来解释。
这里提出的皮质皮质方法对8个皮质下PPs进行分层描述,具有皮质下和皮质融合,代表了在人脑的所有不同进化和不同部分中发现的网络的新系统。
Major depression (MD) and obsessive-compulsive disorder (OCD) are psychiatric diseases with a huge impact on individual well-being. Despite optimal treatment regiments a subgroup of patients remains treatment resistant and stereotactic surgery (stereotactic lesion surgery, SLS or Deep Brain Stimulation, DBS) might be an option. Recent research has described four networks related to MD and OCD (affect, reward, cognitive control, default network) but only on a cortical and the adjacent sub-cortical level. Despite the enormous impact of comparative neuroanatomy, animal science and stereotactic approaches a holistic theory of subcortical and cortical network interactions is elusive. Because of the dominant hierarchical rank of the neocortex, corticofugal approaches have been used to identify connections in subcortical anatomy without anatomical priors and in part confusing results. We here propose a different corticopetal approach by identifying subcortical networks and search for neocortical convergences thereby following the principle of phylogenetic and ontogenetic network development.
This work used a diffusion tensor imaging data from a normative cohort (Human Connectome Project, HCP; n = 200) to describe eight subcortical fiber projection pathways (PPs) from subthalamic nucleus (STN), substantia nigra (SNR), red nucleus (RN), ventral tegmental area (VTA), ventrolateral thalamus (VLT) and mediodorsal thalamus (MDT) in a normative space (MNI). Subcortical and cortical convergences were described including an assignment of the specific pathways to MD/OCD-related networks. Volumes of activated tissue for different stereotactic stimulation sites and procedures were simulated to understand the role of the distinct networks, with respect to symptoms and treatment of OCD and MD.
The detailed course of eight subcortical PPs (stnPP, snrPP, rnPP, vlATR, vlATRc, mdATR, mdATRc, vtaPP/slMFB) were described together with their subcortical and cortical convergences. The anterior limb of the internal capsule can be subdivided with respect to network occurrences in ventral-dorsal and medio-lateral gradients. Simulation of stereotactic procedures for OCD and MD showed dominant involvement of mdATR/mdATRc (affect network) and vtaPP/slMFB (reward network).
Corticofugal search strategies for the evaluation of stereotactic approaches without anatomical priors often lead to confusing results which do not allow for a clear assignment of a procedure to an involved network. According to our simulation of stereotactic procedures in the treatment of OCD and MD, most of the target regions directly involve the reward (and affect) networks, while side-effects can in part be explained with a co-modulation of the control network.
The here proposed corticopetal approach of a hierarchical description of 8 subcortical PPs with subcortical and cortical convergences represents a new systematics of networks found in all different evolutionary and distinct parts of the human brain.