Table 1.
Demographic data and clinical characteristics at the time of surgery.
Fig 1.
Schematic of thalamic involvement in OCD pathophysiology.
MD and VA are embedded within the “direct” positive and “indirect” negative feedback loop of the CSTC circuit and are under striatal influence. Imbalance between direct and indirect pathways results in increased CSTC activity in OCD. Amygdaloid afferents link MD and VA with limbic circuits and enable thalamic processing of emotional stimuli. Increased thalamic output in OCD alters mood and anxiety components. OFC, orbitofrontal cortex; PFC, prefrontal cortex; ACC, anterior cingulate cortex; PMC, premotor cortex; SMA, supplementary motor area; IC, insular cortex; NA, nucleus accumbens; EGP, external globus pallidus; STh, subthalamic nucleus; IGP, internal globus pallidus; SN, substantia nigra; VA, ventral anterior thalamic nucleus; MD, medial dorsal thalamic nucleus.
Fig 2.
Reconstruction of MD and its boundaries.
(A) Coronar section, displaying MD in anterior to posterior-view. (B) Sagittal section of MD. (C) Coronar section of MD in posterior to anterior view. ac, anterior commissure; AV, anteroventral nucleus; CMn, centromedian nucleus; DSf, dorsalis superficialis nucleus; mt, mammillothalamic tract; pc, posterior commissure; vaf, ventral amygdalofugal fibers. Reproduced with permission from Mai JK, Paxinos G (2004): The Human Nervous System, 3rd ed. San Diego Elsevier Academic Press, p 628.
Fig 3.
Reconstruction of VA and its surrounding structures.
(A) Coronar section of VA in anterior to posterior view. (B) anterolateral surface of VA. ac, anterior commissure; AD, anterior dorsal nucleus; AM, anterior medial nucleus; AV, anterior ventral nucleus; DSf, dorsal superficial nucleus; f, fornix; h1, thalamic fascicle; h2, lenticular fascicle; mt, mammillothalamic tract; Pul, Pulvinar; st, stria terminalis; VAL, ventral anterolateral nucleus; VAM, ventral anteromedial nucleus; VL, ventral lateral nucleus; VM, ventromedial nucleus; VMpo, ventromedial posterior nucleus; VPI, ventroposterior inferior nucleus; VPL, ventral posterolateral nucleus. Reproduced with permission from Mai JK, Paxinos G (2004): The Human Nervous System, 3rd ed. San Diego Elsevier Academic Press, p 637.
Fig 4.
Anatomical localization of MD/VA and DBS lead localization according to the Atlas of the Human Brain.
Stereotactic coordinates constitute the centers of active contact points (Case No.-Contact No.) on coronal sections retrieved from postoperative 2D stereotactic X-ray and CCT images. (A) Lead localization within the left hemisphere. (B) Lead placement within the right hemisphere. MDMC, medial dorsal thalamic nucleus, magnocellular part; DSF, dorsal superficial nucleus; bfx, body of fornix; CM, centromedian thalamic nucleus; PF, parafascicular thalamic nucleus; PT, paratenial thalamic nucleus; sm, stria medullaris of thalamus; PV, paraventricular thalamic nucleus; APr, anteroprincipal thalamic nucleus; AD, anterodorsal thalamic nucleus; Cuc, cucullaris nucleus; VA, ventral anterior thalamic nucleus; VM, ventromedial thalamic nucleus; iml, internal medullary lamina of thalamus; CeMe, central medial thalamic nucleus; Co, commissural nucleus; VAMC, ventral anterior thalamic nucleus, magnocellular part; mt, mammillothalamic tract; ithp, inferior thalamic peduncle. Adapted with permission from Mai JK, Paxinos G, Voss T (2007): Atlas of the Human Brain, 3rd ed. San Diego: Elsevier Academic Press.
Table 2.
Coordinates (center of active contacts) of MD/VA electrodes.
Table 3.
Stimulation settings following surgery and in the postoperative course.
Table 4.
Baseline characteristics and outcome of MD/VA stimulation as measured by clinical scales.
Fig 5.
Bar graphs showing the efficacy of MD/VA stimulation.
(A) Y-BOCS. (B) BDI. (C) STAI-X1. (D) STAI-X2. Scores of cases 1, 2, 3 and 4 are shown at presurgical baseline (Baseline) and following lead implantation (1st follow up, 2nd follow up, 3rd follow up). Intervals between follow up visits can be obtained from Table 4.