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在强迫症病例中,解构深度大脑刺激的常见途径概念

Volker A Coenen^1,2,3, Mircea Polosan⁴, Thomas E Schläpfer^5,6

¹Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany. volker.coenen@uniklinik-freiburg.de.

Molecular psychiatry

|April 6, 2025

概括

对抗治疗强迫症障碍 (TR-OCD) 的深度大脑刺激 (DBS) 针对不同的大脑子网络. 超侧中间前脑束 (slMFB) 是一个关键通路,其中包括平均强迫症反应通道 (ORT).

科学领域:

神经科学是一个神经科学.
神经外科神经外科
精神病学是一个精神病学.

背景情况:

深度大脑刺激 (DBS) 是对抗治疗强迫症障碍 (TR-OCD) 的治疗选择.
大脑的强迫症 (OCD) 网络涉及相互连接的子网络,这些子网络在疾病中发生变化,可以通过DBS进行调制.
对DBS数据的Connectomic分析已经确定了负责抗强迫症效应的特定纤维通道.

研究的目的:

通过将刺激结果与激活组织体积相关联来研究TR-OCD中DBS疗效的解剖学基础.
定义超侧面中间前脑束 (slMFB),平均强迫症反应通道 (ORT) 和其他相关大脑结构之间的关系.
探索与TR-OCD中的DBS目标相关的皮质子网络连接.

主要方法:

在两个学术中心接受DBS的26名TR-OCD患者的刺激和结果数据的回顾性分析.
解剖层叠加分析,将单个活化组织 (VAT) 容量与强迫症改善的中介性亚体细胞核 (amSTN) 和slMFB相关联.
对连接组数据 (slMFB,ORT) 进行结构一致性检查和皮质子网络结合的评估.

主要成果:

平均强迫症反应通道 (ORT) 被确定为超侧介质前脑束 (slMFB) 内的纤维选择.
针对amSTN和slMFB的DBS调节了不同的子网络,amSTN DBS可能会影响slMFB.
副网络连接项目到背中前额叶皮质 (dmPFC),被确定为一个关键的枢纽.

结论:

slMFB是一个分散的途径,包括所有强迫症子网络,当在腹部体区域附近受到刺激时,可以作为一个共同的DBS目标.
虽然ORT是slMFB的一部分,但amSTN DBS的抗强迫症效应并不仅仅由ORT参与来解释.
背中介前额叶皮层 (dmPFC) 是强迫症子网络之间的重要结合点.

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