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| Volker Sturm |
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Dept. of Stereotactic and Functional Neurosurgery, University of Cologne, Germany
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Presentation: |
| 2002-10-07, 15:00-15:45 |
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| Substantia innominata - a major target area for DBS in psychiatric disorders. |
| V. Sturm 1, D. Lenartz 1, A. Koulousakis 1, J. Klosterkötter 2 | |
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1 - Dept. of Stereotactic and Functional Neurosurgery
2 - Dept. of Psychiatry, University of Cologne, Germany |
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Clinical experience with two standardized psycho-surgical procedures
(thermo-lesioning of the anterior limbs of the internal capsule and the baso-frontal tractotomy of Knight) prompted us to think about the substantia innominata as a target- structure for deep brain stimulation, the modern and minimal invasive alternative to the aforementioned destructive procedures.
The anterior part of the substantia innominata, within the basal forebrain, is mainly composed of the nucleus accumbens and the extended amygdala. Parts of the nucleus accumbens especially it‘s ventro-caudo-medial edge( shell of the nucleus in humans),play a major role as central relay – structures between limbic system, basal ganglia, dorso-medial thalamus and prefrontal cortex, structures known to be highly relevant in the pathophysiology of psychiatric disease, especially OCD and anxiety disorders.
Since 1999 we have treated 5 patients with severe OCD and anxiety disorders, not responding to medical and psychotherapeutic treatment with DBS of the above mentioned target( shell of nucleus accumbens). The aim was to interrupt the pathological information-flow from the amygdala to the basal ganglia and the prefrontal cortex through unilateral right sided blocking electro- stimulation of the central relay station, resembling a „ bottle neck“ for the projection of pathological bioelectrical impulses through .
2 of 5 patients are now able to live a nearly normal life without major impairment, one is markedly improved ( follow-up 2-2,5 years)
In one patient a technical problem ( dislocation of the electrode ) prohibited a beneficial effect. The fifth patient , who suffered from both OCD and schizophrenia discontinued DBS during the testing period for paranoic thoughts. No side-effects have been observed.
DBS in the substantia innominata may become a powerful tool for treatment of OCD, anxiety disorders and due to the anatomical-physiological properties of this structure even gain significance in the treatment of major psychiatric disorders like schizophrenia and autism. |
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