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

Case report

Bruno Aouizerate M.D., Ph.D. 1 , 2 , Emmanuel Cuny M.D. 2 , 3 , Eric Bardinet Ph.D. 4 , Jerome Yelnik M.D., Ph.D. 5 , Corinne Martin-Guehl M.D., Ph.D. 1 , Jean-Yves Rotge M.D. 1 , 2 , Alain Rougier M.D. 2 , 3 , Bernard Bioulac M.D., Ph.D. 2 , 6 , Jean Tignol M.D. 1 , Luc Mallet M.D., Ph.D. 7 , 8 , Pierre Burbaud M.D., Ph.D. 2 , 6 , and Dominique Guehl M.D., Ph.D. 2 , 6
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  • 1 Service de Psychiatrie, Université Victor Segalen Bordeaux 2, Centre Hospitalier Charles Perrens, Centre Carreire;
  • 2 Laboratoire Mouvement Adaptation Cognition, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 5227;
  • 3 Service de Neurochirurgie;
  • 6 Service de Neurophysiologie Clinique, Université Victor Segalen Bordeaux 2, Centre Hospitalier Universitaire de Bordeaux;
  • 4 Centre National de la Recherche Scientifique, Unité Propre de Recherche 640, Hôpital Pitié-Salpêtrière;
  • 5 Laboratoire Neurologie et Thérapeutique Expérimentale, Institut National de la Santé et de la Recherche Médicale Unité 679, Hôpital Pitié-Salpêtrière;
  • 7 Groupe Avenir Institut National de la Santé et de la Recherche Médicale, «Comportement, Emotion, et Ganglion de la Base», Institut Fédératif de Recherche 70; and
  • 8 Centre d'Investigation Clinique, Hôpital Pitié-Salpêtrière, Paris Cedex 13, France
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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.

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Contributor Notes

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.

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