Deep brain stimulation for treatment-refractory obsessive-compulsive disorder : The search for a valid target. Commentary
Identifieur interne : 002688 ( Main/Exploration ); précédent : 002687; suivant : 002689Deep brain stimulation for treatment-refractory obsessive-compulsive disorder : The search for a valid target. Commentary
Auteurs : Nir Lipsman [Canada] ; Joseph S. Neimat [États-Unis] ; Andres M. Lozano [Canada] ; Philip L. Gildenberg ; Philip A. Starr ; Julie G. Pilitsis ; Roy A. E. Bakay ; Bjorn A. Meyerson ; Brian H. Kopell ; Ali R. RezaiSource :
- Neurosurgery [ 0148-396X ] ; 2007.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Chirurgie.
English descriptors
- KwdEn :
Abstract
Obsessive-compulsive disorder (OCD) is a common psychiatric disease that is marked by recurring, anxiety-provoking thoughts (obsessions) accompanied by repetitive and time-consuming behaviors (compulsions). Among the controversies in the OCD literature is the issue of the origin of the disease and whether brain changes observed with modern imaging techniques are the causes or results of OCD behaviors and thoughts. These issues remain unresolved; however, significant strides have been made in understanding the illness from both phenomenological and pathophysiological perspectives. The current staple of OGO management remains pharmacological in nature and often occurs in conjunction with cognitive behavioral therapy. Refractory cases, however, are occasionally referred for neurosurgical consultation, and several procedures have been examined. Success in the treatment of Parkinson's disease, the reversibility of the therapy, and a relatively safe side-effect profile have allowed deep brain stimulation (DBS) to be examined as an alternative treatment for some psychiatric conditions. Here we assess the possibility of applying DBS to the treatment of OCD. Morphological, functional metabolic, and volumetric data point to several brain regions that are important to the etiology and maintenance of OCD. Converging evidence from the genetics and neurocircuitry literature suggests that several subcortical structures play prominent roles in the disease. The functional modification of these structures could potentially provide symptom relief. Here, we review the ablative and DBS procedures for refractory OCID, and provide a research-driven hypothesis that highlights the ventromedial head of the caudate nucleus, and structures up- and downstream from it, as potential DBS targets for treatment-resistant disease. We hope that a research-driven approach, premised on converging evidence and previous experience, will lead to a safe and effective DBS procedure that will benefit patients who remain disabled despite presently available therapies.
Affiliations:
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Neimat</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Department of Neurological Surgery, Vanderbilt University Medical Center</s1><s2>Nashville, Tennessee</s2><s3>USA</s3><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">Tennessee</region></placeName></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Division of Neurosurgery, Toronto Western Hospital, University Health Network and University of Toronto</s1><s2>Toronto</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto</wicri:noRegion></affiliation></author><author><name sortKey="Gildenberg, Philip L" sort="Gildenberg, Philip L" uniqKey="Gildenberg P" first="Philip L." last="Gildenberg">Philip L. Gildenberg</name></author><author><name sortKey="Starr, Philip A" sort="Starr, Philip A" uniqKey="Starr P" first="Philip A." last="Starr">Philip A. Starr</name></author><author><name sortKey="Pilitsis, Julie G" sort="Pilitsis, Julie G" uniqKey="Pilitsis J" first="Julie G." last="Pilitsis">Julie G. Pilitsis</name></author><author><name sortKey="Bakay, Roy A E" sort="Bakay, Roy A E" uniqKey="Bakay R" first="Roy A. E." last="Bakay">Roy A. E. Bakay</name></author><author><name sortKey="Meyerson, Bjorn A" sort="Meyerson, Bjorn A" uniqKey="Meyerson B" first="Bjorn A." last="Meyerson">Bjorn A. Meyerson</name></author><author><name sortKey="Kopell, Brian H" sort="Kopell, Brian H" uniqKey="Kopell B" first="Brian H." last="Kopell">Brian H. Kopell</name></author><author><name sortKey="Rezai, Ali R" sort="Rezai, Ali R" uniqKey="Rezai A" first="Ali R." last="Rezai">Ali R. Rezai</name></author></analytic><series><title level="j" type="main">Neurosurgery</title><title level="j" type="abbreviated">Neurosurgery</title><idno type="ISSN">0148-396X</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Neurosurgery</title><title level="j" type="abbreviated">Neurosurgery</title><idno type="ISSN">0148-396X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Caudate nucleus</term><term>Encephalon</term><term>Nervous system diseases</term><term>Obsessive compulsive disorder</term><term>Orbitofrontal cortex</term><term>Surgery</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Système nerveux pathologie</term><term>Obsession compulsion</term><term>Chirurgie</term><term>Encéphale</term><term>Traitement</term><term>Noyau caudé</term><term>Cortex orbitofrontal</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Chirurgie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Obsessive-compulsive disorder (OCD) is a common psychiatric disease that is marked by recurring, anxiety-provoking thoughts (obsessions) accompanied by repetitive and time-consuming behaviors (compulsions). Among the controversies in the OCD literature is the issue of the origin of the disease and whether brain changes observed with modern imaging techniques are the causes or results of OCD behaviors and thoughts. These issues remain unresolved; however, significant strides have been made in understanding the illness from both phenomenological and pathophysiological perspectives. The current staple of OGO management remains pharmacological in nature and often occurs in conjunction with cognitive behavioral therapy. Refractory cases, however, are occasionally referred for neurosurgical consultation, and several procedures have been examined. Success in the treatment of Parkinson's disease, the reversibility of the therapy, and a relatively safe side-effect profile have allowed deep brain stimulation (DBS) to be examined as an alternative treatment for some psychiatric conditions. Here we assess the possibility of applying DBS to the treatment of OCD. Morphological, functional metabolic, and volumetric data point to several brain regions that are important to the etiology and maintenance of OCD. Converging evidence from the genetics and neurocircuitry literature suggests that several subcortical structures play prominent roles in the disease. The functional modification of these structures could potentially provide symptom relief. Here, we review the ablative and DBS procedures for refractory OCID, and provide a research-driven hypothesis that highlights the ventromedial head of the caudate nucleus, and structures up- and downstream from it, as potential DBS targets for treatment-resistant disease. We hope that a research-driven approach, premised on converging evidence and previous experience, will lead to a safe and effective DBS procedure that will benefit patients who remain disabled despite presently available therapies.</div></front></TEI><affiliations><list><country><li>Canada</li><li>États-Unis</li></country><region><li>Tennessee</li></region></list><tree><noCountry><name sortKey="Bakay, Roy A E" sort="Bakay, Roy A E" uniqKey="Bakay R" first="Roy A. E." last="Bakay">Roy A. E. Bakay</name><name sortKey="Gildenberg, Philip L" sort="Gildenberg, Philip L" uniqKey="Gildenberg P" first="Philip L." last="Gildenberg">Philip L. Gildenberg</name><name sortKey="Kopell, Brian H" sort="Kopell, Brian H" uniqKey="Kopell B" first="Brian H." last="Kopell">Brian H. Kopell</name><name sortKey="Meyerson, Bjorn A" sort="Meyerson, Bjorn A" uniqKey="Meyerson B" first="Bjorn A." last="Meyerson">Bjorn A. Meyerson</name><name sortKey="Pilitsis, Julie G" sort="Pilitsis, Julie G" uniqKey="Pilitsis J" first="Julie G." last="Pilitsis">Julie G. Pilitsis</name><name sortKey="Rezai, Ali R" sort="Rezai, Ali R" uniqKey="Rezai A" first="Ali R." last="Rezai">Ali R. Rezai</name><name sortKey="Starr, Philip A" sort="Starr, Philip A" uniqKey="Starr P" first="Philip A." last="Starr">Philip A. Starr</name></noCountry><country name="Canada"><noRegion><name sortKey="Lipsman, Nir" sort="Lipsman, Nir" uniqKey="Lipsman N" first="Nir" last="Lipsman">Nir Lipsman</name></noRegion><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name></country><country name="États-Unis"><region name="Tennessee"><name sortKey="Neimat, Joseph S" sort="Neimat, Joseph S" uniqKey="Neimat J" first="Joseph S." last="Neimat">Joseph S. Neimat</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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