title: Deep brain stimulation of the subthalamic nucleus in obsessive-compulsive disorder: Neuroanatomical and pathophysiological considerations.
abstract: Obsessive-compulsive disorder (OCD) is among the most disabling chronic psychiatric disorders and has a significant negative impact on multiple domains of quality of life. For patients suffering from severe refractory OCD, deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been applied. Reviewing the literature of the last years we believe that through its central position within the cortico-basal ganglia-thalamocortical circuits, the STN has a coordinating role in decision-making and action-selection mechanisms. Dysfunctional information-processing at the level of the STN is responsible for some of the core symptoms of OCD. Research confirms an electrophysiological dysfunction in the associative and limbic (non-motor) parts of the STN. Compared to Parkinson׳s disease patients, STN neurons in OCD exhibit a lower firing rate, less frequent but longer bursts, increased burst activity in the anterior ventromedial area, an asymmetrical left-sided burst distribution, and a predominant oscillatory activity in the δ-band. Moreover, there is direct evidence for the involvement of the STN in both checking behavior and OCD symptoms, which are both related to changes in electrophysiological activity in the non-motor STN. Through a combination of mechanisms, DBS of the STN seems to interrupt the disturbed information-processing, leading to a normalization of connectivity within the cortico-basal ganglia-thalamocortical circuits and consequently to a reduction in symptoms. In conclusion, based on the STN׳s strategic position within cortico-basal ganglia-thalamocortical circuits and its involvement in action-selection mechanisms that are responsible for some of the core symptoms of OCD, the STN is a mechanism-based target for DBS in OCD.
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: a.mulders@maastrichtuniversity.nl.
authors.forename: A E P
authors.initials: AEP
authors.lastname: Mulders
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Biomedical Image Analysis, Eindhoven University of Technology, Eindhoven, The Netherlands.
authors.forename: B R
authors.initials: BR
authors.lastname: Plantinga
authors.affiliation: Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Schruers
authors.affiliation: Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Duits
authors.affiliation: Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: M L F
authors.initials: MLF
authors.lastname: Janssen
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Ackermans
authors.affiliation: Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: A F G
authors.initials: AFG
authors.lastname: Leentjens
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Jahanshahi
authors.affiliation: Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Translational Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands. Electronic address: y.temel@maastrichtuniversity.nl.
authors.forename: Y
authors.initials: Y
authors.lastname: Temel
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D009434:Neural Pathways / Q000000981:diagnostic imaging / Q000503:physiopathology; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D020531:Subthalamic Nucleus
keywords: Deep brain stimulation; Functional role; Neuroanatomy; Obsessive-compulsive disorder; Pathophysiology; Subthalamic nucleus