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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(04): e328-e336
DOI: 10.1055/s-0042-1756143
Review Article

Use of Connectomes in Deep Brain Stimulation for the Treatment of Obsessive-Compulsive Disorder

Uso de conectomas na estimulação cerebral profunda para tratamento de transtorno obsessivo-compulsivo
Isabella Amaral Oliveira 
1   School of Medicine, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
,
Maria Clara Rocha Elias Dib 
1   School of Medicine, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
,
Ledismar José da Silva 
1   School of Medicine, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil
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Abstract

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by the performance of repetitive behaviors in response to an obsession, which currently ranks as the tenth cause of disability in the world. Patients who are refractory to conventional treatment are candidates for the neurosurgical treatment of deep brain stimulation (DBS). In this procedure, electrodes are implanted in specific anatomical brain targets. The present systematic literature review aimed to describe the main connectomes and associate them with their respective targets involved in DBS for the treatment of OCD, to understand the connectomes related to OCD and their contributions to DBS, and to describe the main targets used in DBS surgery for OCD. Based on the present results, the stimulated targets that showed better clinical outcomes were the anterior limb of the internal capsule, the nucleus accumbens, the subthalamic nucleus, and the ventral capsule/striatal capsule. The target associated with the worst clinical results was the posterior limb of the anterior commissure. The variable stimulation of certain regions of the brain determines different clinical results. However, an individualized investigation of the OCD patient is essential for choosing the best target for DBS.

Resumo

O transtorno obsessivo-compulsivo (TOC) é uma doença psiquiátrica caracterizada pela realização de comportamentos repetitivos em resposta a uma obsessão, que atualmente se enquadra como a décima causa de incapacidade do mundo. Pacientes refratários ao tratamento convencional são candidatos para o tratamento neurocirúrgico de estimulação cerebral profunda (ECP). Neste procedimento, eletrodos são implantados em alvos anatômicos específicos do cérebro. A presente revisão sistemática da literatura teve como objetivo descrever os principais conectomas e associá-los aos seus respectivos alvos envolvidos no ECP para o tratamento de TOC, compreender os conectomas relacionados ao TOC e suas contribuições para o ECP e descrever os principais alvos utilizados na cirurgia de ECP para TOC. Com base nos nossos resultados, os alvos estimulados que apresentaram melhores resultados clínicos foram o membro anterior da cápsula interna, o núcleo accumbens, o núcleo subtalâmico e cápsula ventral/cápsula estriatal. O alvo associado aos piores resultados clínicos foi o membro posterior da comissura anterior. A estimulação variável de determinadas regiões do cérebro determina resultados clínicos diferentes. No entanto, uma investigação individualizada do paciente com TOC é essencial para a escolha do melhor alvo para ECP.

Keywords

obsessive-compulsive disorder - OCD - deep brain stimulation - DBS - connectome

Palavras-chave

transtorno obsessivo-compulsivo - TOC - estimulação cerebral profunda - ECP - conectoma


Publication History

Received: 24 May 2022

Accepted: 21 June 2022

Article published online:
17 November 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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