title: The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsive- and anxiety-disorders.
abstract: 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 choose the shell region of the right nucleus accumbens as target for deep brain stimulation (DBS) 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 four patients treated. Clinical results as well as a 15-O-H(2)O-PET study, perfomed in one patient during stimulation, speak in favour of the following hypothesis. As a central relay-structure between amygdala, basal ganglia, mesolimbic dopaminergic areas, mediodorsal thalamus and prefrontal cortex, the accumbens nucleus seems to play a modulatory role in information flow from the amygdaloid complex to the latter areas. If disturbed, imbalanced information flow from the amygdaloid complex could yield obsessive-compulsive- and anxiety-disorders, which can be counteracted by blocking the information flow within the shell region of the accumbens nucleus by deep brain stimulation.
authors.affiliation: Department of Stereotactic and Functional Neurosurgery, University of Cologne, 50924, Koln, Germany. volker.sturm@medizin.uni-koeln.de
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm
authors.forename: Doris
authors.initials: D
authors.lastname: Lenartz
authors.forename: Athanasios
authors.initials: A
authors.lastname: Koulousakis
authors.forename: Harald
authors.initials: H
authors.lastname: Treuer
authors.forename: Karl
authors.initials: K
authors.lastname: Herholz
authors.forename: Johannes Christian
authors.initials: JC
authors.lastname: Klein
authors.forename: Joachim
authors.initials: J
authors.lastname: Klosterkötter
mesh_terms: D000818:Animals; D001008:Anxiety Disorders / Q000628:therapy*; D004599:Electric Stimulation Therapy; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging; D009714:Nucleus Accumbens / Q000502:physiology*; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D010865:Pilot Projects; D016896:Treatment Outcome