Deep brain stimulation of the internal capsule enhances human cognitive control and prefrontal cortex function
A S Widge1,2,3, S Zorowitz4,5, I Basu4
1Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, 149 13th St, Boston, MA, 02129, USA. awidge@umn.edu.
Nature Communications
|April 6, 2019
Summary
Deep brain stimulation (DBS) enhances cognitive control by increasing theta oscillations in the prefrontal cortex (PFC). This neurophysiologic change in patients with major depression (MDD) and obsessive-compulsive disorder (OCD) predicts improved clinical outcomes.
Area of Science:
- Neuroscience
- Psychiatry
- Neurosurgery
Background:
- Deep brain stimulation (DBS) is a circuit-based treatment for mental disorders, but its mechanisms of action remain unclear, leading to inconsistent clinical trial results.
- The effectiveness of ventral internal capsule/ventral striatum (VCVS) DBS in both major depression (MDD) and obsessive-compulsive disorder (OCD) suggests a shared underlying mechanism.
- Both MDD and OCD are characterized by deficits in cognitive control, which relies on prefrontal cortex (PFC) pathways projecting to the VCVS.
Purpose of the Study:
- To investigate whether ventral internal capsule/ventral striatum (VCVS) Deep Brain Stimulation (DBS) enhances prefrontal cortex (PFC)-mediated cognitive control.
- To explore the neurophysiological effects of VCVS DBS in the PFC and their correlation with clinical outcomes in patients with major depression (MDD) and obsessive-compulsive disorder (OCD).
Main Methods:
- Human subjects underwent cognitive control tasks during VCVS DBS.
- Electrophysiological recordings were used to measure brain activity, specifically theta oscillations (5-8Hz), in medial and lateral PFC.
- The relationship between neurophysiological changes, task performance, and clinical outcomes was analyzed.
Main Results:
- VCVS DBS significantly improved performance on a cognitive control task in human subjects.
- DBS treatment led to an increase in theta oscillations within both medial and lateral PFC.
- The magnitude of the observed increase in PFC theta oscillations positively predicted clinical outcomes for the subjects.
Conclusions:
- VCVS DBS exerts its therapeutic effects, at least in part, by enhancing PFC-driven cognitive control.
- Increased theta oscillations in the PFC represent a key neurophysiological mechanism underlying the efficacy of DBS for MDD and OCD.
- These findings suggest a potential mechanistic approach for optimizing DBS therapy by tuning stimulation to modulate specific neurophysiologic phenomena.
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