Distinct striatal targets in treating obsessive-compulsive disorder and major depression

Case report

Restricted access

The ventral striatum, including the head of the caudate nucleus and the nucleus accumbens, is a putative target for deep brain stimulation (DBS) in the treatment of obsessive-compulsive disorder (OCD) and major depression (MD). However, the respective roles of these structures in the pathophysiology of OCD and MD remain to be clarified. To address this issue, DBS of the ventral striatum was tested in 2 patients with severely distressing and intractable forms of OCD and MD. Comparisons of clinical outcomes and anatomical data on electrode positioning showed that caudate nucleus stimulation preferentially alleviated OCD manifestations, whereas nucleus accumbens stimulation improved depressive symptoms. These findings suggest that the caudate nucleus and nucleus accumbens participate differently in the pathogenesis of both of these psychiatric conditions.

Abbreviations used in this paper:AC-PC = anterior commissure–posterior commissure; DBS = deep brain stimulation; HDRS = Hamilton Depression Rating Scale; MD = major depression; OCD = obsessive-compulsive disorder; Y-BOCS = Yale-Brown Obsessive-Compulsive Scale.

Article Information

Address correspondence to: Bruno Aouizerate, M.D., Ph.D., Service Universitaire de Psychiatrie Adulte, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5227, Université Victor Segalen Bordeaux 2, Centre Hospitalier Charles Perrens, 121 Rue de la Béchade, 33076 Bordeaux, France. email:bruno.aouizerate@u-bordeaux2.fr.

Please include this information when citing this paper: published online March 13, 2009; DOI: 10.3171/2009.2.JNS0881.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Localization of the stimulating electrodes in the caudate nucleus. A 3D image (A), oblique posterior view, showing 2 electrodes implanted in the head of the caudate nuclei. The nucleus accumbens (blue) and the limbic (yellow), associative (purple), and motor (green) subdivisions of the caudate nucleus have been traced in the 3D atlas of the basal ganglia by using immunohistochemical data. Images depicting the localization of the 4 contacts of each electrode as blue cylinders on transparent views sliced along the trajectory of each electrode for the left and right hemispheres of the patients in Cases 1 (B and C) and 2 (D and E). The volume of tissue activated, as calculated from the voltage and pulse width delivered, is depicted as pink circles of corresponding diameter.

  • View in gallery

    Graph demonstrating psychiatric assessment of depression and OCD symptom severity in the patients in Cases 1 (A) and 2 (B) using the HDRS and Y-BOCS scores per visit: M−1, before progressive discontinuation of the presurgical pharmacological treatment; M0, baseline; and M+1, 1 month; M+3, 3 months; M+6, 6 months; M+9, 9 months; M+12, 12 months; and M+15, 15 months after beginning DBS.

References

  • 1

    Abelson JLCurtis GCSagher OAlbucher RCHarrigan MTaylor SF: Deep brain stimulation for refractory obsessive-compulsive disorder. Biol Psychiatry 57:5105162005

    • Search Google Scholar
    • Export Citation
  • 2

    Aouizerate BCuny EMartin-Guehl CGuehl DAmieva HBenazzouz A: Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive-compulsive disorder and major depression. Case report. J Neurosurg 101:6826862004

    • Search Google Scholar
    • Export Citation
  • 3

    Aouizerate BGuehl DCuny ERougier ABioulac BTignol J: Pathophysiology of obsessive-compulsive disorder: a necessary link between phenomenology, neuropsychology, imagery and physiology. Prog Neurobiol 72:1952212004

    • Search Google Scholar
    • Export Citation
  • 4

    Aouizerate BMartin-Guehl CCuny EGuehl DAmieva HBenazzouz A: Deep brain stimulation for OCD and major depression. Am J Psychiatry 162:21922005

    • Search Google Scholar
    • Export Citation
  • 5

    Ballenger JC: Clinical guidelines for establishing remission in patients with depression and anxiety. J Clin Psychiatry 60:Suppl 2229341999

    • Search Google Scholar
    • Export Citation
  • 6

    Baxter LRFunctional imaging of brain systems mediating obsessive-compulsive disorder: clinical studies. Charney DSNestler EJBunney BS: Neurobiology of Mental Illness New YorkOxford University Press1999. 534547

    • Search Google Scholar
    • Export Citation
  • 7

    Butson CRCooper SEHenderson JMMcIntyre CC: Patientspecific analysis of the volume of tissue activated during deep brain stimulation. Neuroimage 34:6616702007

    • Search Google Scholar
    • Export Citation
  • 8

    Cummings JL: Frontal-subcortical circuits and human behavior. Arch Neurol 50:8738801993

  • 9

    Davidson RJIrwin W: The functional neuroanatomy of emotion and affective style. Trends Cogn Sci 3:11211999

  • 10

    Drevets WC: Neuroimaging studies of mood disorders. Biol Psychiatry 48:8138292000

  • 11

    Gabriels LCosyns PNuttin BDemeulemeester HGybels J: Deep brain stimulation for treatment-refractory obsessivecompulsive disorder: psychopathological and neuropsychological outcome in three cases. Acta Psychiatr Scand 107:2752822003

    • Search Google Scholar
    • Export Citation
  • 12

    Goodman WKPrice LHRasmussen SAMazure CFleischmann RLHill CL: The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 46:100610111989

    • Search Google Scholar
    • Export Citation
  • 13

    Greenberg BDMalone DAFriehs GMRezai ARKubu CSMalloy PF: Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology 31:238423932006

    • Search Google Scholar
    • Export Citation
  • 14

    Guehl DBenazzouz AAouizerate BCuny ERotge JYRougier A: Neuronal correlates of obsessions in the caudate nucleus. Biol Psychiatry 63:5575622008

    • Search Google Scholar
    • Export Citation
  • 15

    Hamilton M: Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 6:2782961967

  • 16

    Karachi CFrancois CParain KBardinet ETande DHirsch E: Three-dimensional cartography of functional territories in the human striatopallidal complex by using calbindin immunoreactivity. J Comp Neurol 450:1221342002

    • Search Google Scholar
    • Export Citation
  • 17

    Mallet LSchupbach MN'Diaye KRemy PBardinet ECzernecki V: Stimulation of subterritories of the subthalamic nucleus reveals its role in the integration of the emotional and motor aspects of behavior. Proc Natl Acad Sci U S A 104:10661106662007

    • Search Google Scholar
    • Export Citation
  • 18

    Mayberg HS: Limbic-cortical dysregulation: a proposed model of depression. J Neuropsychiatry Clin Neurosci 9:4714811997

  • 19

    Mayberg HSLozano AMVoon VMcNeely HESeminowicz DHamani C: Deep brain stimulation for treatmentresistant depression. Neuron 45:6516602005

    • Search Google Scholar
    • Export Citation
  • 20

    Nuttin BCosyns PDemeulemeester HGybels JMeyerson B: Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet 354:15261999. (Letter)

    • Search Google Scholar
    • Export Citation
  • 21

    Pallanti SHollander EBienstock CKoran LLeckman JMarazziti D: Treatment non-response in OCD: methodological issues and operational definitions. Int J Neuropsychopharmacol 5:1811912002

    • Search Google Scholar
    • Export Citation
  • 22

    Phillips MLDrevets WCRauch SLLane R: Neurobiology of emotion perception I: The neural basis of normal emotion perception. Biol Psychiatry 54:5045142003

    • Search Google Scholar
    • Export Citation
  • 23

    Saxena SBrody ALHo MLAlborzian SHo MKMaidment KM: Cerebral metabolism in major depression and obsessive-compulsive disorder occurring separately and concurrently. Biol Psychiatry 50:1591702001

    • Search Google Scholar
    • Export Citation
  • 24

    Schlaepfer TECohen MXFrick CKosel MBrodesser DAxmacher N: Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology 33:3683772008

    • Search Google Scholar
    • Export Citation
  • 25

    Sheehan DVLecrubier YSheehan KHAmorim PJanavs JWeiller E: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59:Suppl 2022331998

    • Search Google Scholar
    • Export Citation
  • 26

    Sturm VLenartz DKoulousakis ATreuer HHerholz KKlein JC: The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsive- and anxiety-disorders. J Chem Neuroanat 26:2932992003

    • Search Google Scholar
    • Export Citation
  • 27

    Yelnik JBardinet EDormont DMalandain GOurselin STande D: A three-dimensional, histological and deformable atlas of the human basal ganglia. I. Atlas construction based on immunohistochemical and MRI data. Neuroimage 34:6186382007

    • Search Google Scholar
    • Export Citation

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 159 159 4
Full Text Views 144 144 4
PDF Downloads 109 109 1
EPUB Downloads 0 0 0

PubMed

Google Scholar