Hilde Demeulemeester

Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder

Chronic electrical stimulation instead of bilateral capsulotomy was done in four selected patients with long-standing treatment-resistant obsessive-compulsive disorder. In three of them beneficial effects were observed.

LONG‐TERM ELECTRICAL CAPSULAR STIMULATION IN PATIENTS WITH OBSESSIVE‐COMPULSIVE DISORDER

OBJECTIVEBecause of the irreversibility of lesioning procedures and their possible side effects, we studied the efficacy of replacing bilateral anterior capsulotomy with chronic electrical capsular stimulation in patients with severe, long-standing, treatment-resistant obsessive-compulsive disorder. METHODSWe stereotactically implanted quadripolar electrodes in both anterior limbs of the internal capsules into six patients with severe obsessive-compulsive disorder. Psychiatrists and psychologists performed a double-blind clinical assessment. A blinded random crossover design was used to assess four of those patients, who underwent continuous stimulation thereafter. RESULTSThe psychiatrist-rated Yale-Brown Obsessive Compulsive Scale score was lower in the stimulation-on condition (mean, 19.8 ± 8.0) than in the postoperative stimulator-off condition (mean, 32.3 ± 3.9), and this stimulation-induced effect was maintained for at least 21 months after surgery. The Clinical Global Severity score decreased from 5 (severe; standard deviation, 0) in the stimulation-off condition to 3.3 (moderate to moderate-severe; standard deviation, 0.96) in the stimulation-on condition. The Clinical Global Improvement scores were unchanged in one patient and much improved in the other three during stimulation. During the stimulation-off period, symptom severity approached baseline levels in the four patients. Bilateral stimulation led to increased signal on functional magnetic resonance imaging studies, especially in the pons. Digital subtraction analysis of preoperative [18F]2-fluoro-2-deoxy-d-glucose positron emission tomographic scans and positron emission tomographic scans obtained after 3 months of stimulation showed decreased frontal metabolism during stimulation. CONCLUSIONThese observations indicate that capsular stimulation reduces core symptoms 21 months after surgery in patients with severe, long-standing, treatment-refractory obsessive-compulsive disorder. The stimulation elicited changes in regional brain activity as measured by functional magnetic resonance imaging and positron emission tomography.

Deep brain stimulation for treatment-refractory obsessive-compulsive disorder: psychopathological and neuropsychological outcome in three cases

Objective:  Investigation of deep brain stimulation (DBS) as a last‐resort treatment alternative to capsulotomy in treatment‐refractory obsessive‐compulsive disorder (OCD).

Heterogeneity of GABAergic cells in cat visual cortex

Antibodies against neuropeptides and against a vitamin D-dependent calcium-binding protein (CaBP) label small cells with nonpyramidal-like morphology in the cat visual cortex (areas 17, 18, and 19). Since GABAergic cells are interneurons, a double-staining procedure was used to test for the coexistence of cholecystokinin (CCK), somatostatin (SRIF), neuropeptide Y (NPY), corticotropin-releasing factor (CRF), vasoactive intestinal polypeptide (VIP), and CaBP with glutamic acid decarboxylase (GAD). Our results show that CRF and VIP do not coexist with GAD, while the 3 other peptides and CaBP do. Hence GAD-positive cells can be subdivided into 4 broad groups: (1) cells that are only GAD-positive, (2) cells that are GAD- and CaBP-positive, (3) GAD- positive neurons also containing CCK, and (4) GAD-positive cells that also contain SRIF. A small subset of class 2 also contains SRIF and most cells of class 4 also contain NPY. The 4 classes of GAD-positive cells differ in laminar position: class 1 predominates in layers IV and V, classes 2 and 3 in the upper laminae (II and III), and class 4 in the deepest layer (VI).

Calbindin D-28K and parvalbumin immunoreactivity is confined to two separate neuronal subpopulations in the cat visual cortex, whereas partial coexistence is shown in the dorsal lateral geniculate nucleus

Calbindin D-28K-immunoreactive cells were localized in the supragranular layers of the striate cortex of the cat, while parvalbumin-stained cells occurred from the bottom half of layer II through layer VI, making the two distributions almost complementary. Calbindin- and parvalbumin-positive cells occurred throughout the 3 layers of the dorsal lateral geniculate nucleus (dLGN), but calbindin-immunoreactive cells outnumbered parvalbumin-positive cells. Double labeling on single sections was performed in order to determine the possible coexistence of calbindin and parvalbumin in single cells of cat visual cortex and dLGN. Calbindin and parvalbumin immunoreactivity was found in two separate neuronal populations in the visual cortex, while in the dLGN about 50% of the cells were doubly stained.

Identification of the target neuronal elements in electrical deep brain stimulation

The aim of this study is to identify the primary neuronal target elements in electrical deep‐brain stimulation, taking advantage of the difference in strength–duration time constant (τsd) of large myelinated axons (≈ 30–200 µs), small axons (≈ 200–700 µs) and cell bodies and dendrites (≈ 1–10 ms). Strength–duration data were measured in patients suffering from Parkinsons disease or essential tremor and treated by high‐frequency stimulation in the ventral intermediate thalamic nucleus or the internal pallidum. Threshold voltages for the elimination of tremor were determined at various pulsewidths and a pulse rate of 130 pulses per second. The τsd was calculated using Weisss linear approximation. Its mean value was 64.6 ± 25.4 µs (SD) for the thalamic nucleus and 75.3 ± 25.5 µs for the internal pallidum. Corrections to the mean values were made because the τsd values were based on voltage–duration measurements using polarizable electrodes. Apart from this systematic error, a resolution error, due to the relatively large increment steps of the pulse amplitude, was taken into account, resulting in mean τsd estimates of 129 and 151 µs for the thalamic nucleus and the internal pallidum, respectively. It is concluded that the primary targets of stimulation in both nuclei are most probably large myelinated axons.

Chronaxie calculated from current-duration and voltage-duration data.

To determine the rheobase and the chronaxie of excitable cells from strength-duration curves both constant-current pulses and constant-voltage pulses are applied. Since the complex impedance of the electrode-tissue interface varies with both the pulsewidth and the stimulation voltage, chronaxie values estimated from voltage-duration measurements will differ from the proper values as determined from current-duration measurements. To allow a comparison of chronaxie values obtained by the two stimulation methods, voltage-duration curves were measured in human subjects with a deep brain stimulation electrode implanted, while the current and the load impedance of the stimulation circuit were determined in vitro as a function of both stimulation voltage and pulsewidth. Chronaxie values calculated from voltage-duration data were shown to be 30-40% below those estimated from current-duration data. It was also shown that in the normal range of stimulation amplitudes (up to 7 V) the load impedance increases almost linearly with the pulsewidth. This result led us to present a simple method to convert voltage-duration data into current-duration data, thereby reducing the error in the calculated chronaxie values to approximately 6%. For this purpose voltage-duration data have to be measured for pulses up to 10-20 times the expected chronaxie.

Cardiovascular autonomic function in conscious rats: a novel approach to facilitate stationary conditions.

Background An experimental setting and software were developed to evaluate cardiovascular autonomic function in conscious rats. A restrained approach was used, which, upon proper habituation, induced little or no stress in the rats and limited motion artifacts.

Effects Of Melanocortins On Cardiovascular Regulation In Rats

1. Of the melanocortin peptides, γ2‐melanocyte‐stimulating hormone (MSH) has been attributed a cardiovascular effect, inducing an increase in blood pressure and heart rate. Although still controversial, this effect, based on pharmacological blockade experiments, is supposed to be mediated through sympathetic activation.

Immunocytochemical localization of somatostatin and cholecystokinin in the cat visual cortex

Immunocytochemistry was used to examine the morphology and distribution of cholecystokinin-like and somatostatin-like neurons in areas 17, 18 and 19 of cat visual cortex as a function of lamination. Immunoreactive cells of both peptides were observed in all layers of cat visual cortex. While somatostatin-like cells occurred mainly in layers II + III and VI, cholecystokinin-like cells were observed chiefly in the superficial layers (I + II + III). Somatostatin-like cells displayed morphological features of multipolar and bipolar varieties, and cholecystokinin-like cells displayed morphological features of multipolar and bitufted varieties. Similar results were obtained for all 3 areas.