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LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00004808naa a2200481 4500
001oai:DiVA.org:umu-202434
003SwePub
008230109s2022 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-2024342 URI
0247 a https://doi.org/10.1176/appi.focus.201052 DOI
040 a (SwePub)umu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Tyagi, Himanshu4 aut
2451 0a A randomized trial directly comparing ventral capsule and anteromedial subthalamic nucleus stimulation in obsessive-compulsive disorder :b Clinical and imaging evidence for dissociable effects
264 1b American Psychiatric Association Publishing,c 2022
338 a print2 rdacarrier
500 a Appeared originally in Biological Psychiatry 2019; 85:726-734. Reprinted under Creative Commons CC-BY license.Reprint from: Himanshu Tyagi, Annemieke M. Apergis-Schoute et al., "A Randomized Trial Directly Comparing Ventral Capsule and Anteromedial Subthalamic Nucleus Stimulation in Obsessive-Compulsive Disorder: Clinical and Imaging Evidence for Dissociable Effects", Biiological Psychiatry, 2019:85, 726-734, DOI: 10.1016/j.biopsych.2019.01.017
520 a Background: Deep brain stimulation (DBS) is an emerging treatment for severe obsessive-compulsive disorder (OCD). We compared the efficacy of ventral capsule/ventral striatal (VC/VS) and anteromedial subthalamic nucleus (amSTN) DBS in the same patients and tested for mechanistic differences on mood and cognitive flexibility and associated neural circuitry. The possible synergistic benefit of DBS at both sites and cognitive behavioral therapy was explored.Methods: Six patients with treatment-refractory OCD (5 men; Yale-Brown Obsessive Compulsive Scale score >32) entered double-blind counterbalanced phases of 12-week amSTN or VC/VS DBS, followed by 12-week open phases when amSTN and VC/VS were stimulated together, in which optimal stimulation parameters were achieved and adjunctive inpatient cognitive behavioral therapy was delivered. OCD and mood were assessed with standardized scales and cognitive flexibility with the Cambridge Neuropsychological Test Automated Battery Intra-Extra Dimensional Set-Shift task. Diffusion-weighted and intraoperative magnetic resonance imaging scans were performed for tractography from optimally activated electrode contacts.Results: DBS at each site significantly and equivalently reduced OCD symptoms with little additional gain following combined stimulation. amSTN but not VC/VS DBS significantly improved cognitive flexibility, whereas VC/VS DBS had a greater effect on mood. The VC/VS effective site was within the VC. VC DBS connected primarily to the medial orbitofrontal cortex, and amSTN DBS to the lateral orbitofrontal cortex, dorsal anterior cingulate cortex, and dorsolateral prefrontal cortex. No further improvement followed cognitive behavioral therapy, reflecting a floor effect of DBS on OCD.Conclusions: Both the VC/VS and amSTN are effective targets for severe treatment-refractory OCD. Differential improvements in mood and cognitive flexibility and their associated connectivity suggest that DBS at these sites modulates distinct brain networks.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Neurologi0 (SwePub)302072 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Neurology0 (SwePub)302072 hsv//eng
653 a neurokirurgi
653 a Neurosurgery
7001 a Apergis-Schoute, Annemieke M.4 aut
7001 a Akram, Harith4 aut
7001 a Foltynie, Tom4 aut
7001 a Limousin, Patricia4 aut
7001 a Drummond, Lynne M.4 aut
7001 a Fineberg, Naomi A.4 aut
7001 a Matthews, Keith4 aut
7001 a Jahanshahi, Marjan4 aut
7001 a Robbins, Trevor W.4 aut
7001 a Sahakian, Barbara J.4 aut
7001 a Zrinzo, Ludvic4 aut
7001 a Hariz, Marwanu Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, UK; he National Hospital for Neurology and Neurosurgery, London, UK4 aut0 (Swepub:umu)hama0032
7001 a Joyce, Eileen M.4 aut
7102 a Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, UK; he National Hospital for Neurology and Neurosurgery, London, UK4 org
7730 t FOCUSd : American Psychiatric Association Publishingg 20:1, s. 160-169q 20:1<160-169x 1541-4094x 1541-4108
8564 u https://discovery.dundee.ac.uk/ws/files/48643298/PIIS0006322319300630.pdf
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-202434
8564 8u https://doi.org/10.1176/appi.focus.20105

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