Unit:
Κατεύθυνση Κλινική και Πειραματική ΝευροχειρουργικήLibrary of the School of Health Sciences
Supervisors info:
Καλαματιανός Θεοδόσης Επίκουρος Καθηγητής, Τμήμα Μηχανικών Βιοϊατρικής, ΠΑΔΑ
Στράντζαλης Γιώργος, Καθηγητής ,Ιατρική Σχολή, ΕΚΠΑ
Τσάμης Κωνσταντίνος, Επικουρος Καθηγητής, Ιατρική Σχολή, Πανεπιστήμιο Ιωαννίνων
Original Title:
The human bed nucleus of the stria terminalis as a deep brain stimulation target: a systematic scoping review
Translated title:
The human bed nucleus of the stria terminalis as a deep brain stimulation target: a systematic scoping review
Summary:
Introduction
The human bed nucleus of stria terminalis (BNST) is a bilateral medial basal forebrain structure of approximately 190mm3 that is also referred to as part of the extended amygda-la. The nucleus is bordered dorsally by the lateral ventricles and caudate nucleus, laterally by the internal capsule and ventrally / ventromedially by the anterior commissure, nucleus accumbens, hypothalamic preoptic area and fornix. The human BNST displays well con-served structural connections with the hypothalamus and additional limbic areas, such as the amygdala, the insula and nucleus accumbens. Neurocircuitry involving the BNST has been previously implicated in anxiety disorders and addiction. Recent evidence-based guide-lines for deep brain stimulations for Obsessive-Compulsive Disorder (OCD) by the Congress of Neurological Surgeons indicate the utility of bilateral stimulation of the BSNT. Case se-ries with BNST stimulation as Major Depressive Disorder (MDD) treatment are also pub-lished.
Aims
The present study aimed at mapping the available literature on the utility of the BNST as a target of deep brain stimulation in humans.
Material -methods
We employed a systematic review methodology according to PRISMA guidelines. MeSH terms that were selected for a Pubmed search were: (Bed nucleus of stria terminalis) or (BNST) and (Stimulation). Time period was set from January 1973 - March 2024. Animal studies as well as letters to the Editor, conference papers and those written in a language other than English were excluded. Case series involving 4 or less participants were exclud-ed. Studies involving the BNST activation without therapeutic objectives were also not in-cluded.
Results
The present systematic review identified 10 manuscripts assessing the therapeutic po-tential of BNST stimulation in OCD. Only one study assessed the utility of BNST stimula-tion in MDD. Out of 107 patients with OCD 58 were full responders (>35% YBOCS reduc-tion). Out of 5 patients with MDD 2 patients were responders. Good outcome was asso-ciated with the turned-on phases of the system and was observed in the long-term pe-riod. Bilateral stimulation was not related to enhanced outcome. 7 patients with OCD had major psychiatric complications, such as suicidal attempts, hypomanic episodes and psychotic reaction. On the contrary 2 patients with MDD attempted suicide.
Conclusions
BNST neurocircuitry is implicated in anxiety and addiction disorders. Bilateral BNST stimu-lation has been indicated as a putative therapeutic target against OCD. Patient selection based on strict criteria is still debatable. While a benefit of BNST stimulation in OCD is sup-ported by several studies on small numbers of patients, more research is warranted to as-sess utility in both OCD and other disorders.
Main subject category:
Health Sciences
Keywords:
Bed nucleus of the stria terminals, Deep brain stimulation, Obsessive compulsive disorder
Number of references:
256
