Tiefe Hirnstimulation bei Zwangsstörungen

Zusammenfassung

Die Zwangsstörung ist die erste psychiatrische Erkrankung, für die eine offizielle CE-Zertifizierung und FDA-Zulassung als Humanitarian Device Exemption (HDE) zur Behandlung mittels Tiefer Hirnstimulation vorliegt. Die offizielle Indikation ist die Stimulation der vorderen inneren Kapsel zur Behandlung von chronischer, schwerer, therapieresistenter obsessiv-kompulsiver Erkrankung bei Erwachsenen. Die Stimulation benachbarter Gebiete der ventralen Capsula/des ventralen Striatums und des Nucleus accumbens scheint hinsichtlich der Wirksamkeit von Belang zu sein. Ferner liegen positive Daten zur Stimulation anderer Zielgebiete wie dem Nuclues subthalamicus vor. Die Evidenzlage ist noch nicht ausreichend für die abschließende Bewertung der Zielpunkte. Prospektive Studien zum Vergleich der Zielpunkte laufen.

Abstract

Treatment of obsessive compulsive disorder (OCD) is the first CE-marked and FDA approved psychiatric indication for deep brain stimulation. Severe chronic, therapy-refractive OCD in adults has become an official indication for stimulation of the anterior limb of the internal capsule. Stimulation of the ventral capsula/ventral striatum/Ncl. accumbens seems to play a key role in that target area. Stimulation of the subthalamic nucleus seems to be also beneficial. More evidence for the most efficient target is emerging through upcoming trials that compare different targets.

Schlüsselwörter

Tiefe Hirnstimulation - Zwangsstörung - OCD

Key words

deep brain stimulation - obsessive compulsive ­disorder - OCD

• Literatur

• 1 Abramowitz JS, Taylor S, McKay D. Obsessive-compulsive disorder. Lancet 2009; 374: 491-499
• 2 Menzies L, Chamberlain SR, Laird AR et al. Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: the orbitofronto-striatal model revisited. Neurosci Biobehav Rev 2008; 32: 525-549
• 3 Bartsch C, Kuhn J. Deep brain stimulation for addiction, anorexia and compulsion: Rationale, clinical results and ethical implications. Nervenarzt 2014; 26: 162-168
• 4 Beucke JC, Sepulcre J, Talukdar T et al. Abnormally high degree connectivity of the orbitofrontal cortex in obsessive-compulsive disorder. JAMA psychiatry 2013; 70: 619-629
• 5 Lipsman N, Giacobbe P, Lozano AM. Deep brain stimulation in obsessive-compulsive disorder: neurocircuitry and clinical experience. Handb Clin Neurol 2013; 116: 245-250
• 6 Nuttin B, Cosyns P, Demeulemeester H et al. Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. 1999; 354: 13353
• 7 De Koning PP, Figee M, van den Munckhof P et al. Current status of deep brain stimulation for obsessive-compulsive disorder: a clinical review of different targets. Curr Psychiatry Rep 2011; 13: 274-282
• 8 Blomstedt P, Sjöberg RL, Hansson M et al. Deep brain stimulation in the treatment of obsessive-compulsive disorder. World Neurosurg 2013; 80: e245-e253
• 9 Greenberg BD, Gabriels La, Malone D et al. Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry 2010; 15: 64-79
• 10 Denys D, Mantione M, Figee M et al. Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Arch Gen Psychiatry 2010; 67: 1061-1068
• 11 Ooms P, Mantione M, Figee M et al. Deep brain stimulation for obsessive-compulsive disorders: long-term analysis of quality of life. J Neurol Neurosurg Psychiatry 2014; 85: 153-158
• 12 Huff W, Lenartz D, Schormann M et al. Unilateral deep brain stimulation of the nucleus accumbens in patients with treatment-resistant obsessive-compulsive disorder: Outcomes after one year. Clin Neurol Neurosurg 2010; 112: 137-143
• 13 Kubu CS, Malone Da, Chelune G et al. Neuropsychological outcome after deep brain stimulation in the ventral capsule/ventral striatum for highly refractory obsessive-compulsive disorder or major depression. Stereotact Funct Neurosurg 2013; 91: 374-378
• 14 Chang WS, Roh D, Kim C-H et al. Combined bilateral anterior cingulotomy and ventral capsule/ventral striatum deep brain stimulation for refractory obsessive-compulsive disorder with major depression: do combined procedures have a long-term benefit?. Restor Neurol Neurosci 2013; 31: 723-732
• 15 Mallet L, Mesnage V, Houeto JL et al. Compulsions, Parkinson’s disease, and stimulation. Lancet 2002; 360: 1302-1304
• 16 Fontaine D, Mattei V, Borg M et al. Effect of subthalamic nucleus stimulation on obsessive-compulsive disorder in a patient with Parkinson disease. Case report. J Neurosurg 2004; 100: 1084-1086
• 17 Weintraub DB, Zaghloul Ka. The role of the subthalamic nucleus in cognition. Rev Neurosci 2013; 18: 1-14
• 18 Mallet L, Polosan M, Jaafari N et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med 2008; 359: 2121-2134
• 19 Jiménez F, Nicolini H, Lozano AM et al. Electrical stimulation of the inferior thalamic peduncle in the treatment of major depression and obsessive compulsive disorders. World Neurosurg 80: S30.e17-S30.e25
• 20 Bajwa RJ, Lotbinie AJ. De: Deep Brain Stimulation in Tourette’ s Syndrome. 2007; 22: 1346-1350
• 21 Nair G, Evans A, Bear RE et al. The anteromedial GPi as a new target for deep brain stimulation in obsessive compulsive disorder. J Clin Neurosci 2013; Oct 23 DOI: 10.1016/j.jocn.2013.10.003.
• 22 Le Jeune F, Vérin M, N’Diaye K et al. Decrease of prefrontal metabolism after subthalamic stimulation in obsessive-compulsive disorder: a positron emission tomography study. Biol Psychiatry 2010; 68: 1016-1022
• 23 Bastin J, Polosan M, Piallat B et al. Changes of oscillatory activity in the subthalamic nucleus during obsessive compulsive disorder symptoms: two case reports. Cortex 2014; DOI: 10.1016/j.cortex.2013.12.007.
• 24 Burbaud P, Clair A-H, Langbour N et al. Neuronal activity correlated with checking behaviour in the subthalamic nucleus of patients with obsessive-compulsive disorder. Brain 2013; 136: 304-317
• 25 Welter M-L, Burbaud P, Fernandez-Vidal S et al. Basal ganglia dysfunction in OCD: subthalamic neuronal activity correlates with symptoms severity and predicts high-frequency stimulation efficacy. Transl Psychiatry 2011; 1: e5
• 26 Piallat B, Polosan M, Fraix V et al. Subthalamic neuronal firing in obsessive-compulsive disorder and Parkinson disease. Ann Neurol 2011; 69: 793-802
• 27 Neumann W-J, Huebl J, Brücke C et al. Different patterns of local field potentials from limbic DBS targets in patients with major depressive and obsessive compulsive disorder. Mol Psychiatry 2014; DOI: 10.1038/mp.2014.2.
• 28 Figee M, Luigjes J, Smolders R et al. Deep brain stimulation restores frontostriatal network activity in obsessive-compulsive disorder. Nat Neurosci 2013; 16: 386-387
• 29 Greenberg BD, Malone DA, Friehs GM et al. Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive-Compulsive. Disorder 2006; 2384-2393