What is the Role of the Subthalamic Nucleus in Obsessive–Compulsive Disorder? Elements and Insights from Deep Brain Stimulation Studies

  • William I. A. Haynes
  • Luc MalletEmail author


The use of subthalamic deep brain stimulation for the treatment of obsessive–compulsive disorder (OCD) is the consequence of two unexpected clinical observations. After we have described the clinical studies, we will attempt to provide an explanation for the sometimes spectacular effects observed, before discussing what these and related functional experiments bring to the understanding of OCD pathophysiological mechanisms and the role of the subthalamic nucleus.


Deep Brain Stimulation Subthalamic Nucleus Sham Stimulation Subthalamic Stimulation Subthalamic Deep Brain Stimulation 
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  1. Afsharpour S (1985) Topographical projections of the cerebral cortex to the subthalamic nucleus. J Comp Neurol 236:14–28PubMedCrossRefGoogle Scholar
  2. Bevan MD, Clarke NP, Bolam JP (1997) Synaptic integration of functionally diverse pallidal information in the entopeduncular nucleus and subthalamic nucleus in the rat. J Neurosci 17:308–324PubMedGoogle Scholar
  3. Bogacz R, Larsen T (2011) Integration of reinforcement learning and optimal decision-making theories of the basal ganglia. Neural Comput 23:817–851PubMedCrossRefGoogle Scholar
  4. Bradbury C, Cassin SE, Rector NA (2011) Obsessive beliefs and neurocognitive flexibility in obsessive-compulsive disorder. Psychiatry Res 187:160–165PubMedCrossRefGoogle Scholar
  5. Chaturvedi A, Butson CR, Lempka SF, Cooper SE, McIntyre CC (2010) Patient-specific models of deep brain stimulation: influence of field model complexity on neural activation predictions. Brain Stimul 3:65–67PubMedCrossRefGoogle Scholar
  6. Chua EF, Schacter DL, Sperling RA (2009) Neural correlates of metamemory: a comparison of feeling-of-knowing and retrospective confidence judgments. J Cogn Neurosci 21:1751–1765PubMedCrossRefGoogle Scholar
  7. Eagle DM, Baunez C (2010) Is there an inhibitory-response-control system in the rat? Evidence from anatomical and pharmacological studies of behavioral inhibition. Neurosci Biobehav Rev 34:50–72PubMedCrossRefGoogle Scholar
  8. Figee M, Vink M, de Geus F, Vulink N, Veltman DJ, Westenberg H, Denys D (2011) Dysfunctional reward circuitry in obsessive-compulsive disorder. Biol Psychiatry 69:867–874PubMedCrossRefGoogle Scholar
  9. Fontaine D, Mattei V, Borg M, von Langsdorff D, Magnie MN, Chanalet S, Robert P, Paquis P (2004) Effect of subthalamic nucleus stimulation on obsessive-compulsive disorder in a patient with Parkinson disease. Case report. J Neurosurg 100:1084–1086PubMedCrossRefGoogle Scholar
  10. Frank MJ (2006) Hold your horses: a dynamic computational role for the subthalamic nucleus in decision making. Neural Netw 19:1120–1136PubMedCrossRefGoogle Scholar
  11. Frank MJ, Samanta J, Moustafa AA, Sherman SJ (2007) Hold your horses: impulsivity, deep brain stimulation, and medication in parkinsonism. Science 318:1309–1312PubMedCrossRefGoogle Scholar
  12. Haynes WIA, Mallet L (2010) High-frequency stimulation of deep brain structures in obsessive-compulsive disorder: the search for a valid circuit. Eur J Neurosci 32:1118–1127PubMedCrossRefGoogle Scholar
  13. Hershey T, Campbell MC, Videen TO, Lugar HM, Weaver PM, Hartlein J, Karimi M, Tabbal SD, Perlmutter JS (2010) Mapping Go-No-Go performance within the subthalamic nucleus region. Brain 133:3625–3634PubMedCrossRefGoogle Scholar
  14. Houeto JL, Mallet L, Mesnage V, Tezenas du Montcel S, Behar C, Gargiulo M, Torny F, Pelissolo A, Welter ML, Agid Y (2006) Subthalamic stimulation in Parkinson disease: behavior and social adaptation. Arch Neurol 63:1090–1095PubMedCrossRefGoogle Scholar
  15. Huebl J, Schoenecker T, Siegert S, Brucke C, Schneider GH, Kupsch A, Yarrow K, Kuhn AA (2011) Modulation of subthalamic alpha activity to emotional stimuli correlates with depressive symptoms in Parkinson’s disease. Mov Disord 26:477–483PubMedCrossRefGoogle Scholar
  16. Kepecs A, Uchida N, Zariwala HA, Mainen ZF (2008) Neural correlates, computation and behavioural impact of decision confidence. Nature 455:227–231PubMedCrossRefGoogle Scholar
  17. Koprivova J, Congedo M, Horacek J, Prasko J, Raszka M, Brunovsky M, Kohutova B, Hoschl C (2011) EEG source analysis in obsessive-compulsive disorder. Clin Neurophysiol 122:1735–1743PubMedCrossRefGoogle Scholar
  18. Kuhn AA, Kempf F, Brucke C, Gaynor Doyle L, Martinez-Torres I, Pogosyan A, Trottenberg T, Kupsch A, Schneider GH, Hariz MI, Vandenberghe W, Nuttin B, Brown P (2008) High-frequency stimulation of the subthalamic nucleus suppresses oscillatory beta activity in patients with Parkinson’s disease in parallel with improvement in motor performance. J Neurosci 28:6165–6173PubMedCrossRefGoogle Scholar
  19. Le Jeune F, Verin M, N’Diaye K, Drapier D, Leray E, Du Montcel ST, Baup N, Pelissolo A, Polosan M, Mallet L, Yelnik J, Devaux B, Fontaine D, Chereau I, Bourguignon A, Peron J, Sauleau P, Raoul S, Garin E, Krebs MO, Jaafari N, Millet B (2010) Decrease of prefrontal metabolism after subthalamic stimulation in obsessive-compulsive disorder: a positron emission tomography study. Biol Psychiatry 68:1016–1022PubMedCrossRefGoogle Scholar
  20. Mallet L, Mesnage V, Houeto JL, Pelissolo A, Yelnik J, Behar C, Gargiulo M, Welter ML, Bonnet AM, Pillon B, Cornu P, Dormont D, Pidoux B, Allilaire JF, Agid Y (2002) Compulsions, Parkinson’s disease, and stimulation. Lancet 360:1302–1304PubMedCrossRefGoogle Scholar
  21. Mallet L, Schupbach M, N’Diaye K, Remy P, Bardinet E, Czernecki V, Welter ML, Pelissolo A, Ruberg M, Agid Y, Yelnik J (2007) Stimulation of subterritories of the subthalamic nucleus reveals its role in the integration of the emotional and motor aspects of behavior. Proc Natl Acad Sci U S A 104:10661–10666PubMedCrossRefGoogle Scholar
  22. Mallet L, Polosan M, Jaafari N, Baup N, Welter ML, Fontaine D, du Montcel ST, Yelnik J, Chereau I, Arbus C, Raoul S, Aouizerate B, Damier P, Chabardes S, Czernecki V, Ardouin C, Krebs MO, Bardinet E, Chaynes P, Burbaud P, Cornu P, Derost P, Bougerol T, Bataille B, Mattei V, Dormont D, Devaux B, Verin M, Houeto JL, Pollak P, Benabid AL, Agid Y, Krack P, Millet B, Pelissolo A (2008) Subthalamic nucleus stimulation in severe obsessive–compulsive disorder. N Engl J Med 359:2121–2134PubMedCrossRefGoogle Scholar
  23. McIntyre CC, Mori S, Sherman DL, Thakor NV, Vitek JL (2004) Electric field and stimulating influence generated by deep brain stimulation of the subthalamic nucleus. Clin Neurophysiol 115:589–595PubMedCrossRefGoogle Scholar
  24. Meiran N, Diamond GM, Toder D, Nemets B (2011) Cognitive rigidity in unipolar depression and obsessive compulsive disorder: examination of task switching, Stroop, working memory updating and post-conflict adaptation. Psychiatry Res 185:149–156PubMedCrossRefGoogle Scholar
  25. Piallat B, Polosan M, Fraix V, Goetz L, David O, Fenoy A, Torres N, Quesada JL, Seigneuret E, Pollak P, Krack P, Bougerol T, Benabid AL, Chabardes S (2011) Subthalamic neuronal firing in obsessive-compulsive disorder and Parkinson disease. Ann Neurol 69:793–802PubMedCrossRefGoogle Scholar
  26. Sauleau P, Eusebio A, Thevathasan W, Yarrow K, Pogosyan A, Zrinzo L, Ashkan K, Aziz T, Vandenberghe W, Nuttin B, Brown P (2009) Involvement of the subthalamic nucleus in engagement with behaviourally relevant stimuli. Eur J Neurosci 29:931–942PubMedCrossRefGoogle Scholar
  27. Vicente S, Biseul I, Peron J, Philippot P, Drapier S, Drapier D, Sauleau P, Haegelen C, Verin M (2009) Subthalamic nucleus stimulation affects subjective emotional experience in Parkinson’s disease patients. Neuropsychologia 47:1928–1937PubMedCrossRefGoogle Scholar
  28. Voon V (2004) Repetition, repetition, and repetition: compulsive and punding behaviors in Parkinson’s disease. Mov Disord 19:367–370PubMedCrossRefGoogle Scholar
  29. Welter ML, Burbaud P, Fernandez-Vidal S, Bardinet E, Coste J, Piallat B, Borg M, Besnard S, Sauleau P, Devaux B, Pidoux B, Chaynes P, Tezenas du Montcel S, Bastian A, Langbour N, Teillant A, Haynes W, Yelnik J, Karachi C, Mallet L (2011) Basal ganglia dysfunction in OCD: subthalamic neuronal activity correlates with symptoms severity and predicts high-frequency stimulation efficacy. Transl Psychiatry 1:e5PubMedCrossRefGoogle Scholar
  30. Yelnik J, Bardinet E, Dormont D, Malandain G, Ourselin S, Tande D, Karachi C, Ayache N, Cornu P, Agid Y (2007) A three-dimensional, histological and deformable atlas of the human basal ganglia. I. Atlas construction based on immunohistochemical and MRI data. Neuroimage 34:618–638PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Team—Behavior, Emotion, and Basal Ganglia, Pitié-Salpêtrière Hospital, ICM—Brain and Spine InstituteUPMC—Inserm UMR_S 975, CNRS UMR 7225ParisFrance

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