Deep brain stimulation : from neurology to psychiatry?

TLDR: The concept that dysfunction of motor, limbic and associative cortico-basal ganglia-thalamocortical loops underlies these various disorders, which might now be amenable to DBS treatment, is discussed.

About: This article is published in Trends in Neurosciences.The article was published on 2010-10-01 and is currently open access. It has received 287 citations till now. The article focuses on the topics: Deep brain stimulation & Psychosurgery.

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Table 1. Mood, personality and behaviour in Parkinson’s diseasea

Figure 1. Schematic diagram illustrating the main cortico-basal ganglia–thalamocortical circuits within human brain. This figure shows a pseudo-anatomical arrangement of the motor, associative and limbic pathways. (a) Motor circuit. Neurons from the sensorimotor cortex project to the posterolateral putamen (Put). From the putamen there are two main projections topographically organized onto the posterolateral region of the target nuclei: (i) the direct circuit to the GPi and (ii) the indirect circuit connecting the posterior putamen to the globus pallidus pars externa (GPe), the STN and the GPi. The GPi is the primary output nucleus of the basal ganglia to the cortex via the ventrolateral thalamus. (b) Associative circuit. This circuit originates in the dorsolateral prefrontal and lateral orbitofrontal cortices, which project to the caudate nucleus (Cn) and anteromedial portion of the putamen. From the striatum (Cn + Put) it projects to the dorsomedial region of the GPi and anteromedial parts of the GPe and STN to converge onto the GPi and back to the cortex via the ventral anterior nuclei of the thalamus. (c) Limbic circuit. This loop starts in the hippocampus, amygdala and paralimbic and limbic cortices and projects to the ventral striatum (ventral portion of the caudate and putamen, including NAcc). The ventral striatum projects to the limbic portion of the GPe and medioventral STN and ventral GPi and to the cortex via the mediodorsal nucleus of the thalamus. Adapted, with permission, from Ref. [140] .

Figure 2. DBS targets for depression, OCD and GTS. Axial human brain magnetic resonance image (MRI) at the level of the anterior and posterior commissure showing the brain targets in which DBS has been applied to treat depression (green), OCD (red) and GTS (blue). Blue targets underlined in red are common to OCD and GTS. Cg 25, Brodmann area 25 of the subgenual cingulate cortex; Ant IC, anterior interior capsule (which can be targeted at its most anterior or most posterior part); GPi, globus pallidus internus; VC, ventral caudate; GPe, globus pallidus externus; Zi, zona incerta.

Table 2. Interventions aimed at BG–thalamocortical loops in human patientsa