The Nucleus Accumbens: A Target for Deep- Brain Stimulation in Obsessive-Compulsive and Anxiety Disorders

  • V. Sturm
  • D. Lenartz
  • A. Koulousakis
  • H. Treuer
  • K. Herholz
  • J. C. Klein
  • J. Klosterkötter

Summary

We considered clinical observations in patients with obsessive-compulsive and anxiety disorders who underwent bilateral anterior capsulotomy, as well as anatomical and pathophysiological findings. Based on these considerations, we chose the shell region of the right nucleus accumbens as the target for deep-brain stimulation in a pilot series of four patients with severe obsessive-compulsive and anxiety disorders. Significant reduction in severity of symptoms has been achieved in three of the four patients treated. Clinical results, as well as a 15O-H2O-PET study performed in one patient during stimulation, speak in favor of the following hypothesis: As a central relay structure between the amygdala, basal ganglia, mesolimbic dopaminergic areas, mediodorsal thalamus, and prefrontal cortex, the nucleus accumbens seems to play a modulatory role in the flow of information from the amygdaloid complex to the latter areas. If disturbed, an imbalanced information flow from the amygdaloid complex can yield obsessive-compulsive and anxiety disorders. These can be counteracted by blocking the information flow within the shell region of the nucleus accumbens by means of deep-brain stimulation (DBS).

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References

  1. 1.
    Alheid GF, Beltramino CA, de Olmos JS, Forbes MS, Swanson DJ, Heimer L (1998) The neuronal organization of the supracapsular part of the stria terminalis in the rat: the dorsal component of the extended amygdala. Neuroscience 84: 967–996PubMedCrossRefGoogle Scholar
  2. 2.
    Benabid AL, Pollak P, Gervason C, Hoffmann D, Gao DM, Hommel M, Perret JE, De Rougemont J (1991) Long-term suppression of tremor by chronic stimulation of ventral intermediate thalamic nucleus. Lancet 337: 402–406CrossRefGoogle Scholar
  3. 3.
    Blond S, Caparros-Lefebvre D, Parker F, Assaker R, Petit H, Guieu JD, Christiaens JL (1992) Control of tremor and involuntary movement disorders by chronic stereotactic stimulation of the ventral intermediate thalamic nucleus. J Neurosurg 77: 62–68PubMedCrossRefGoogle Scholar
  4. 4.
    de Olmos J, Heimer L (1999) The concepts of the ventral striatopallidal system and extended amygdala. Ann NY Acad Sci 877: 1–31PubMedCrossRefGoogle Scholar
  5. 5.
    Grace AA (1993) Cortical regulation of subcortical dopamine systems and its possible relevance to schizophrenia. J Neural Transm 9: 111–134CrossRefGoogle Scholar
  6. 6.
    Haber SN (2003) The basal ganglia: parallel and integrative networks. J Chem Neuroanat this volumeGoogle Scholar
  7. 7.
    Haber SN, Fudge JL, McFarland NR (2000) Striatonigrostriatal pathways in primates form an ascending spiral from the shell to the dorsolateral striatum. J Neurosci 20: 2369–2382PubMedGoogle Scholar
  8. 8.
    Heimer L (2000) Basal forebrain in the context of schizophrenia. Brain Res Rev 31: 205–235PubMedCrossRefGoogle Scholar
  9. 9.
    Heimer L, Harlan RE, Alheid GF, Garcia M, de Olmos J (1997) Substantia innominata: a notion which impedes clinical-anatomical correlations in neuropsychiatric disorders. Neuroscience 76: 957–1006PubMedCrossRefGoogle Scholar
  10. 10.
    Jenike MA (1998) Neurosurgical treatment of obsessive-compulsive disorder. Br J. Psychiatry [Suppl] 35: 79–90Google Scholar
  11. 11.
    Le Doux JE (2000) Emotion circuits in the brain. Annu Rev Neurosci 23: 155–184CrossRefGoogle Scholar
  12. 12.
    Lippitz BE, Mindus P, Meyerson BA, Kihlstrom L, Lindqvist C (1999) Lesion topography and outcome after thermo-capsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder: relevance of the right hemisphere. Neurosurgery 44: 452–458PubMedCrossRefGoogle Scholar
  13. 13.
    Mai JK, Assheuer J, Paxinos G (1997) Atlas of the human brain. Academic Press, San DiegoGoogle Scholar
  14. 14.
    Matthysse S (1973) Antipsychotic drug actions: a clue to the neuropathology of schizophrenia? Fed Proc 32: 200–205PubMedGoogle Scholar
  15. 15.
    Meyerson BA (1998) Neurosurgical treatment of mental disorders: introduction and indications. In: Gildenberg PL, Tasker RR (eds) Textbook of stereotactic and functional neurosurgery. McGraw-Hill, New York, pp 1953–1963Google Scholar
  16. 16.
    Mulder AB, Hodenpijl MG, Lopes da Silva FH (1998) Electrophysiology of the hippocampal and amygdaloid projections to the nucleus accumbens of the rat: convergence, segregation, and interaction of inputs. J Neurosci 18: 5059–5102Google Scholar
  17. 17.
    Nuttin B, Cosyns P (1999) Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet 354: 1526PubMedCrossRefGoogle Scholar
  18. 18.
    Rauch SL, Dougherty DD, Cosgrove JR, Cassem EH, Alpert NM, Price BH, Nierenberg AA, Mayberg HS, Baer L, Jenike MA, Fischman AJ (2001) Cerebral metabolic correlates as potential predictors of response to anterior cingulotomy for obsessive compulsive disorder. Biol Psychiatry 50: 659–667PubMedCrossRefGoogle Scholar
  19. 19.
    Rosenkranz JA, Grace AA (1999) Modulation of basolateral amygdala neuronal firing and afferent drive by dopamine receptor activation in vivo. J Neurosci 15: 11027–11039Google Scholar
  20. 20.
    Saxena S, Rauch SL (2000) Functional neuroimaging and the neuroanatomy of obsessive-compulsive disorder. Psychiatr Clin North Am 23: 563–586PubMedCrossRefGoogle Scholar
  21. 21.
    Schuurman PR, Bosch DA, Bossuyt PM, Bonsel GJ, van Someren EJ, de Bie RM, et al (2000) A comparison of continuous thalamic stimulation and thalamotomy for supression of severe tremor. N Engl J Med 342: 461–468PubMedCrossRefGoogle Scholar
  22. 22.
    Shumyatsky GP, Tsvetkov E, Malleret G, Vronskaya S, Hatton M, Hampton L, Battey JF, Dulac C, Kandel ER, Bolshakov VG (2002) Identification of a signaling network in lateral nucleus of amygdala important for inhibiting memory specifically related to learned fear. Cell 111: 905–918PubMedCrossRefGoogle Scholar
  23. 23.
    Stevens JR (1973) An anatomy of schizophrenia? Arch Gen Psychiatry 29: 177–189PubMedGoogle Scholar
  24. 24.
    Volkmann J, Sturm V, Weiss P, Kappler J, Voges J, Koulousakis A, Lehrke R, Hefter H, Freund HJ (1998) Bilateral high-frequency stimulation of the internal globus pallidus in advanced Parkinson’s disease. Ann Neurol 44: 953–961PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag Heidelberg 2007

Authors and Affiliations

  • V. Sturm
    • 1
  • D. Lenartz
    • 1
  • A. Koulousakis
    • 1
  • H. Treuer
    • 1
  • K. Herholz
    • 2
  • J. C. Klein
    • 2
  • J. Klosterkötter
    • 3
  1. 1.Department of Stereotactic and Functional NeurosurgeryUniversity of CologneKölnGermany
  2. 2.Department of Neurology and Max Planck- Institute for Neurological ResearchCologneGermany
  3. 3.Department of PsychiatryUniversity of CologneCologneGermany

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