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. 2022 Jan;164(1):193-202.
doi: 10.1007/s00701-021-04991-0. Epub 2021 Oct 15.

Distribution of electric field in patients with obsessive compulsive disorder treated with deep brain stimulation of the bed nucleus of stria terminalis

Matilda Naesström  1 , Johannes Johansson  2 , Marwan Hariz  3   4 , Owe Bodlund  5 , Karin Wårdell  2 , Patric Blomstedt  3
Affiliations

Distribution of electric field in patients with obsessive compulsive disorder treated with deep brain stimulation of the bed nucleus of stria terminalis

Matilda Naesström et al. Acta Neurochir (Wien). 2022 Jan.

Abstract

Background: Deep brain stimulation (DBS) is being investigated as a treatment for therapy-refractory obsessive compulsive disorder (OCD). Many different brain targets are being trialled. Several of these targets such as the ventral striatum (including the nucleus accumbens (NAc)), the ventral capsule, the inferior thalamic peduncle, and the bed nucleus of stria terminalis (BNST)) belong to the same network, are anatomically very close to one another, or even overlap. Data is still missing on how various stimulation parameters in a given target will affect surrounding anatomical areas and impact the clinical outcome of DBS.

Methods: In a pilot study of eleven participants with DBS of the BNST, we investigate through patient-specific simulation of electric field, which anatomical areas are affected by the electric field, and if this can be related to the clinical results. Our study combined individual patient's stimulation parameters at 12- and 24-month follow-up with image data from the preoperative MRI and postoperative CT. These data were used to calculate the distribution of electric field and create individual anatomical models of the field of stimulation.

Results: The individual electric stimulation fields by stimulation in the BNST were similar at both the 12- and 24-month follow-up, involving mainly anterior limb of the internal capsule (ALIC), genu of the internal capsule (IC), BNST, fornix, anteromedial globus pallidus externa (GPe), and the anterior commissure. A statistical significant correlation (p < 0.05) between clinical effect measured by the Yale-Brown Obsessive Compulsive Scale and stimulation was found at the 12-month follow-up in the ventral ALIC and anteromedial GPe.

Conclusions: Many of the targets under investigation for OCD are in anatomical proximity. As seen in our study, off-target effects are overlapping. Therefore, DBS in the region of ALIC, NAc, and BNST may perhaps be considered to be stimulation of the same target.

Keywords: Bed nucleus of stria terminalis (BNST); Deep brain stimulation (DBS); Electric field; Obsessive compulsive disorder (OCD); Simulation.

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Conflict of interest statement

Matilda Naesström, Johannes Johansson, and Owe Bodlund have no conflict of interest.

Karin Wårdell is a shareholder in FluoLink AB.

Patric Blomstedt is a consultant for Abbott, Boston Scientific, and Medtronic and a shareholder in Mithridaticum AB.

Marwan Hariz received lecturing fees from Boston Scientific.

Figures

Fig. 1
Fig. 1
The encircled areas show individual electric fields at 12 months’ follow-up in each of the 11 patients
Fig. 2
Fig. 2
Finite element method model of two Medtronics 3387 leads visualized along the plane of the electrodes. The deepest contact lies 3 mm below the AC-PC plane
Fig. 3
Fig. 3
Group simulation fields at 12 months’ follow-up
Fig. 4
Fig. 4
Anatomical target overview
See this image and copyright information in PMC

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