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Deep brain stimulation in the ALIC-BNST region targeting the bed nucleus of stria terminalis in patients with obsessive–compulsive disorder: effects on cognition after 12 months
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper.ORCID-id: 0000-0002-7063-9710
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
Department of Biomedical Engineering, Linköping University, Linköping, Sweden.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper. Unit of Functional Neurosurgery, Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, United Kingdom.ORCID-id: 0000-0001-5930-6037
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2023 (Engelska)Ingår i: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 165, nr 5, s. 1201-1214Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Purpose: The aim of this study was to evaluate cognitive effects 12 months after Deep Brain Stimulation (DBS) of the Bed Nucleus of Stria Terminalis (BNST) in patients with refractory Obsessive–Compulsive Disorder (OCD).

Methods: Eight patients (5 female; mean ± SD age 36 ± 15) with OCD were included. A neuropsychological test battery covering verbal and spatial episodic memory, executive function, and attention was administered preoperatively and 12 months after surgery. Medical records were used as a source for descriptive data to probe for any changes not covered by standardized checklists and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the primary outcome measure.

Results: At 12 months, seven patients showed response to DBS: three were full responders (i.e., Y-BOCS ≥ 35% improvement), and four were partial responders (Y-BOCS 25–34% improvement). Relative to baseline, there was a slight decline on visuo-spatial learning (p = 0.027), and improved performance on the Color-Word Interference inhibition/switching subtest (p = 0.041), suggesting improvement in cognitive flexibility.

Conclusions: DBS in the BNST for treatment refractory OCD generates very few adverse cognitive effects and improves cognitive flexibility after 12 months of stimulation. The improvement in Y-BOCS and the absence of major cognitive side effects support the BNST as a potential target for DBS in severe OCD.

Ort, förlag, år, upplaga, sidor
Springer, 2023. Vol. 165, nr 5, s. 1201-1214
Nyckelord [en]
Bed nucleus of stria terminalis, BNST, Cognition, Deep brain stimulation, DBS, Obsessive–compulsive disorder, OCD
Nationell ämneskategori
Neurologi Neurovetenskaper
Identifikatorer
URN: urn:nbn:se:umu:diva-199475DOI: 10.1007/s00701-022-05351-2ISI: 000849141100001PubMedID: 36056244Scopus ID: 2-s2.0-85137480737OAI: oai:DiVA.org:umu-199475DiVA, id: diva2:1697366
Tillgänglig från: 2022-09-20 Skapad: 2022-09-20 Senast uppdaterad: 2023-09-21Bibliografiskt granskad
Ingår i avhandling
1. Cognitive effects of deep brain stimulation: focus on caudal zona incerta for essential tremor and Parkinson´s disease, and on bed nucleus of stria terminalis for obsessive compulsive disorder
Öppna denna publikation i ny flik eller fönster >>Cognitive effects of deep brain stimulation: focus on caudal zona incerta for essential tremor and Parkinson´s disease, and on bed nucleus of stria terminalis for obsessive compulsive disorder
2023 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Kognitiva effekter av deep brain stimulation (djup hjärnstimulering) : fokus på caudal zona incerta vid essentiell tremor och Parkinsons sjukdom, samt på bed nucleus stria terminalis vid tvångssyndrom
Abstract [en]

Preserved cognition is an important determinant for perceived Quality of Life (QoL) and has been found to be essential in order to translate improvements in primary symptoms following Deep Brain Stimulation (DBS) into activities of daily living that drive QoL. Therefore, it is important to evaluate not only the clinical improvement, but also the cognitive impact of DBS.

The aim of this thesis was to evaluate the cognitive effects of DBS in a new target, the caudal Zona incerta (cZi), which has shown promising results in patients with both Parkinson’s Disease (PD) and Essential Tremor (ET). Given that this is a novel target, the effects on cognition were lacking in the literature. In the same manner, the cognitive effects in patients with Obsessive-Compulsive Disorder (OCD) receiving DBS in the Bed Nucleus of Stria Terminalis (BNST) lacked long-term follow-up.

The main findings from the studies included in this thesis, suggest that DBS in the cZi in patients with PD and ET, and in the BNST in patients with OCD, does not generate any major cognitive effects and can be considered safe from a cognitive perspective.However, subtle effects involving aspects of executive function may be present following cZi DBS in patients with PD. Significant results concerned primarily a decrease in selective attention and aspects of inhibition. cZi DBS in patients with ET generated fewer cognitive effects, including a decrease in semantic verbal fluency 12 months after DBS in the cZi. fMRI results evaluating the effects of cZi DBS on brain activity during a working memory task, did not show any significant changes when DBS was ON or OFF. This study also revealed a significant Task-x-DBS interaction, with faster response times during DBS ON relative to DBS OFF for the more cognitively demanding “manipulation” task. In OCD patients with BNST DBS, improved results on the Color-Word Inhibition/switching subtest were found, indicating a possible improvement in cognitive flexibility. However, there was a decrease of performance in visuo-spatial learning at 12 months after surgery.

The studies in patients with PD and ET were the first to report comprehensive neuropsychological data regarding cZi DBS. The fMRI study was the first in patients with ET treated with cZi DBS, focusing on cognitive effects during a working memory task in on/off DBS conditions. The OCD study was the first to report long-term data on cognitive effects after BNST DBS. By showing that DBS in these targets does not produce any major cognitive side effects, valuable knowledge in terms of safety has been added. This will hopefully contribute to increased treatment options in DBS.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University, 2023. s. 79
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2226
Nyckelord
Deep brain stimulation. Neuropsychology. Cognition. Parkinson’s disease. Essential tremor. Obsessive-compulsive disorder. Caudal zona incerta. Bed nucleus of stria terminalis. Functional MRI.
Nationell ämneskategori
Neurovetenskaper
Forskningsämne
neurologi
Identifikatorer
urn:nbn:se:umu:diva-204361 (URN)978-91-7855-995-4 (ISBN)978-91-7855-996-1 (ISBN)
Disputation
2023-03-03, Hörsal D, målplan T, plan 9, Norrlands universitetssjukhus, Umeå, 09:00 (Engelska)
Opponent
Handledare
Anmärkning

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Tillgänglig från: 2023-02-10 Skapad: 2023-02-02 Senast uppdaterad: 2023-02-08Bibliografiskt granskad

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