Anatomy and physiology of the basal ganglia: implications for DBS in psychiatry.
The basal ganglia have been a target for neuromodulation surgery since Russell Meyers' pioneering works in the late 1930s. Contemporary movement disorder surgery on the brain has evolved from empiric observations on movement behavior after neurological lesions. So too has the development of psychiatric surgical procedures followed the observation of lesions in the brain on cognitive and affective behavior. Just as deep brain stimulation (DBS) has revolutionized the practice of movement disorder surgery, its application to psychiatric illness has become the cutting edge of functional and restorative neurosurgery. The fundamental concept of the cortico-striatal-pallido-thalamocortical loop will be explored in the context of psychiatric disorders. DBS targeting this circuitry appears from initial evidence in obsessive-compulsive disorder (OCD) to be a promising option for patients with neuropsychiatric illness resistant to conventional therapies. Further exploring the anatomic interconnectivity of the physiologically relevant cortical and subcortical areas will inevitably lead to better applications of DBS for the treatment of OCD, major depression (MD) and potentially for other psychiatric disorders. Implementing such therapies optimally will require the creation of treatment centers with specialized expertise in the psychiatric, neurosurgical, and ethical issues that arise with these populations.
Kopell
Brian Harris
BH
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA. bkopell@mcw.edu
Greenberg
Benjamin D
BD
D000341:Affective Disorders, Psychotic / Q000523:psychology / Q000628:therapy; D001479:Basal Ganglia / Q000033:anatomy & histology / Q000502:physiology* / Q000503:physiopathology; D002540:Cerebral Cortex / Q000033:anatomy & histology / Q000502:physiology / Q000503:physiopathology; D046690:Deep Brain Stimulation / Q000379:methods / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy; D006801:Humans; D008032:Limbic System / Q000033:anatomy & histology / Q000502:physiology / Q000503:physiopathology; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy