Functional MRI Evaluation of Deep Brain Stimulation of Bed Nucleus of Stria Terminalis in Obsessive-Compulsive Disorder

• Deep brain stimulation (DBS) is under investigation as a treatment for resistant obsessivecompulsive disorder (OCD). OCD is theorized to be caused by dysregulation in corticostriato-thalamo-cortical networks, including structures associated with emotional and cognitive processing such as the bed nucleus of stria terminalis (BNST), pre-supplementary motor area (pre-SMA) and anterior insula. As a crucial part of the anxiety circuit the BNST has been proposed as a target for DBS in OCD. However, the mechanism of action of BNST DBS in OCD is not yet fully understood. The aim of this study was to investigate how DBS affects anxiety-related brain activity in patients with severe obsessive-compulsive disorder, and explore which areas of the brain are possibly involved in the treatment. Six patients undergoing DBS in the BNST for sever OCD were evaluated with symptom provocation fMRI pre-operatively and in DBS on and off conditions. Anxiety-related brain activity was identified by contrasting anxiety-provoking images versus neutral images, and included the anterior insula and the pre-SMA. In the pre-SMA a significant decrease was seen in 3/6 patients, with a nominally similar reduction in the other three patients. In the anterior insula, the change was significant in half of the patients, again showing a similar pattern across the whole group. We hypothesize that possible mechanisms of BNST DBS in OCD could be modulation of anxiety related activity in the pre-SMA and anterior insula, two regions that plays an important role in the pathophysiology of OCD.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Psykiatri (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Psychiatry (hsv//eng)

Nyckelord

deep brain stimulation (DBS)

obsessive-compulsive disorder (OCD)

bed nucleus of stria terminalis (BNST)

functional magnetic resonance imaging

psykiatri

Psychiatry

Publikations- och innehållstyp

vet (ämneskategori)

ovr (ämneskategori)