title: Deep brain stimulation for obsessive-compulsive disorder: subthalamic nucleus target.
abstract: Because of its reversibility and adaptability, deep brain stimulation (DBS) has recently gained interest in psychiatric disorders, such as obsessive-compulsive disorders (OCD) and depression. In OCD, DBS is now an alternative procedure to lesions of fascicles such as the anterior capsule, which links the orbitofrontal cortex, the cingulum, and the thalamus, and has been applied to new target such as the nucleus accumbens, with promising results. However, a recent interest has been developed toward the subthalamic nucleus (STN), a key structure of the basal ganglia that connects the motor, limbic, and associative systems. It is known from patients with Parkinson disease that STN-DBS can have significant effects on mood and cognition. Those transient effects are usually seen as "side effects" in Parkinson disease, but are clues to the underappreciated role that STN plays in the limbic circuitry, a role whose precise details are as yet unknown and under active investigation. We present the rationale supporting the use of nonmotor STN as a therapeutic target to treat OCD. In particular, we discuss the recent experience and preliminary results of our group after 6 months of nonmotor STN-DBS in patients with severe OCD.
authors.affiliation: Université Joseph Fourier, Grenoble, France; Clinique de Neurochirurgie, Centre Hospitalier Universitaire, Grenoble, France; INSERM U836, Grenoble Institut des Neurosciences, Grenoble, France. Electronic address: SChabardes@chu-grenoble.fr.
authors.forename: Stéphan
authors.initials: S
authors.lastname: Chabardès
authors.forename: Mircea
authors.initials: M
authors.lastname: Polosan
authors.forename: Paul
authors.initials: P
authors.lastname: Krack
authors.forename: Julien
authors.initials: J
authors.lastname: Bastin
authors.forename: Alexandre
authors.initials: A
authors.lastname: Krainik
authors.forename: Olivier
authors.initials: O
authors.lastname: David
authors.forename: Thierry
authors.initials: T
authors.lastname: Bougerol
authors.forename: Alim Louis
authors.initials: AL
authors.lastname: Benabid
mesh_terms: D000328:Adult; D017668:Age of Onset; D000818:Animals; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000523:psychology / Q000601:surgery; D008297:Male; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D009771:Obsessive-Compulsive Disorder / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D018579:Patient Selection; D020531:Subthalamic Nucleus / Q000473:pathology / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome