Jens Kuhn

University Hospital Cologne

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Veerle Visser‐Vandewalle

University of Cologne

Juan Carlos Baldermann

University Hospital Cologne

Daniel Huys

University of Cologne

Doris Lenartz

Witten/Herdecke University

Joachim Klosterkötter

University of Cologne

W. Huff

St. Marien Hospital

Sina Kohl

University Hospital Cologne

Thomas Schüller

University Hospital Cologne

Lars Timmermann

Philipps University of Marburg

V. Sturm

University of Cologne

Cooperative Institutions

University of Cologne

140

University Hospital Cologne

106

University of Hertfordshire

University of Chieti-Pescara

Università Cattolica del Sacro Cuore

University of Lausanne

Inserm

Klinik und Poliklinik für Psychiatrie und Psychotherapie

Centre National de la Recherche Scientifique

Charité - Universitätsmedizin Berlin

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A Synergistic Treatment Strategy for Severe Obsessive Compulsive Disorder

Neuromodulation Technology at the Neural Interface (2016)

Sina Kohl Juan Carlos Baldermann Damiaan Denys Jens Kuhn

10.1111/ner.12461

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Citations (6)

Serotonin deficiency and psychiatric long COVID: both caused specifically by the virus itself or an adaptive general stress response?

European Archives of Psychiatry and Clinical Neuroscience (2024)

Udo Bonnet Jens Kuhn

2019-20 coronavirus outbreak

10.1007/s00406-024-01769-0

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Citations (3)

Remission of alcohol dependency following deep brain stimulation of the nucleus accumbens: valuable therapeutic implications?

Journal of Neurology Neurosurgery & Psychiatry (2007)

Jens Kuhn Doris Lenartz W. Huff Stuart Lee A. Koulousakis

Chronic consumption of alcohol represents one of the greatest health and socioeconomic problems worldwide. We report on a 54-year-old patient with a severe anxiety disorder and secondary depressive disorder in whom bilateral deep brain stimulation (DBS) of the nucleus accumbens was carried out. Despite the absence of desired improvement in his primary disorder, we observed a remarkable although not primarily intended alleviation of the patient's comorbid alcohol dependency. Our case report demonstrates the extremely effective treatment of alcohol dependency by means of DBS of the nucleus accumbens and may reveal new prospects in overcoming therapy resistance in dependencies in general.

Alcohol use disorder

Alcohol Dependence

10.1136/jnnp.2006.113092

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Citations (287)

Eine Option beim schweren Tourette-Syndrom?

InFo Neurologie + Psychiatrie (2017)

Jens Kuhn

10.1007/s15005-017-2379-7

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Tiefe Hirnstimulation eröffnet eine neue Option bei psychiatrischen Erkrankungen

InFo Neurologie + Psychiatrie (2020)

Jens Kuhn Michael Grözinger Alexander Sartorius

10.1007/s15005-020-1341-2

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A Critical Role of Action-Related Functional Networks in Gilles de la Tourette Syndrome

Juan Carlos Baldermann Jan Niklas Petry‐Schmelzer Thomas Schüller Lin Mahfoud Gregor A. Brandt

Gilles de la Tourette Syndrome (GTS) is the most severe form of chronic tic disorders, characterized by uncontrollable motor actions and vocalizations. While brain stimulation techniques show promise in reducing tic severity, optimal target networks are not well-defined. Here, we leveraged datasets from two independent deep brain stimulation (DBS) cohorts and a cohort of tic-inducing lesions to infer critical networks for treatment and occurrence of tics by mapping stimulation sites and lesions to a functional connectome derived from 1,000 healthy participants. We found that greater tic reduction is linked to higher connectivity of DBS sites (N = 37) with action-related functional resting-state networks, i.e., the cingulo-opercular (R = 0.62; p < 0.001) and somato-cognitive action networks (R = 0.47; p = 0.002). Hubs within the cingulo-opercular network best matched the optimal connectivity profiles of thalamic DBS. We replicated the significance of targeting cingulo-opercular and somato-cognitive action network connectivity in an independent DBS cohort (N = 10). Finally, we demonstrate that tic-inducing brain lesions (N = 22) exhibit similar connectivity to these networks. Collectively, these results suggest a critical role for these action-related networks in the pathophysiology and treatment of GTS.

10.31219/osf.io/jxwmn

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Frontiers in Human Neuroscience (2021)

Elena Sildatke Thomas Schüller Theo O.J. Gründler Markus Ullsperger Veerle Visser‐Vandewalle

For successful goal-directed behavior, a performance monitoring system is essential. It detects behavioral errors and initiates behavioral adaptations to improve performance. Two electrophysiological potentials are known to follow errors in reaction time tasks: the error-related negativity (ERN), which is linked to error processing, and the error positivity (Pe), which is associated with subjective error awareness. Furthermore, the correct-related negativity (CRN) is linked to uncertainty about the response outcome. Here we attempted to identify the involvement of the nucleus accumbens (NAc) in the aforementioned performance monitoring processes. To this end, we simultaneously recorded cortical activity (EEG) and local field potentials (LFP) during a flanker task performed by four patients with severe opioid abuse disorder who underwent electrode implantation in the NAc for deep brain stimulation. We observed significant accuracy-related modulations in the LFPs at the time of the ERN/CRN in two patients and at the time of Pe in three patients. These modulations correlated with the ERN in 2/8, with CRN in 5/8 and with Pe in 6/8, recorded channels, respectively. Our results demonstrate the functional interrelation of striatal and cortical processes in performance monitoring specifically related to error processing and subjective error awareness.

Error-related negativity

Local field potential

Frontal cortex

Negativity effect

10.3389/fnhum.2020.627564

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Citations (3)

Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response

PLoS ONE (2015)

Pino Alonso Daniel Cuadras Loes Gabriëls Damiaan Denys Wayne K. Goodman

Background Deep brain stimulation (DBS) has been proposed as an alternative to ablative neurosurgery for severe treatment-resistant Obsessive-Compulsive Disorder (OCD), although with partially discrepant results probably related to differences in anatomical targetting and stimulation conditions. We sought to determine the efficacy and tolerability of DBS in OCD and the existence of clinical predictors of response using meta-analysis. Methods We searched the literature on DBS for OCD from 1999 through January 2014 using PubMed/MEDLINE and PsycINFO. We performed fixed and random-effect meta-analysis with score changes (pre-post DBS) on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) as the primary-outcome measure, and the number of responders to treatment, quality of life and acceptability as secondary measures. Findings Thirty-one studies involving 116 subjects were identified. Eighty-three subjects were implanted in striatal areas—anterior limb of the internal capsule, ventral capsule and ventral striatum, nucleus accumbens and ventral caudate—27 in the subthalamic nucleus and six in the inferior thalamic peduncle. Global percentage of Y-BOCS reduction was estimated at 45.1% and global percentage of responders at 60.0%. Better response was associated with older age at OCD onset and presence of sexual/religious obsessions and compulsions. No significant differences were detected in efficacy between targets. Five patients dropped out, but adverse effects were generally reported as mild, transient and reversible. Conclusions Our analysis confirms that DBS constitutes a valid alternative to lesional surgery for severe, therapy-refractory OCD patients. Well-controlled, randomized studies with larger samples are needed to establish the optimal targeting and stimulation conditions and to extend the analysis of clinical predictors of outcome.

Subthalamic Nucleus

Ventral striatum

Caudate nucleus

Tolerability

10.1371/journal.pone.0133591

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Citations (366)

Schwerpunktheft EKT

Fortschritte der Neurologie · Psychiatrie (2018)

Jens Kuhn Wolfgang Gäebel

Die auf die maßgeblichen Ideen von Ladislav von Meduna und Ugo Cerletti zurückgehende Elektrokonvulsionstherapie (EKT) stellt eines der ältesten und zugleich effektivsten Therapieverfahren in der Psychiatrie dar [1]. Insbesondere für schwer behandelbare depressive Störungen belegen Metaanalysen die überlegene Wirksamkeit des Verfahrens, z. B. im Vergleich zu pharmakologischen Ansätzen. In manchen Studien zeigten sich Remissionsraten für die wahnhafte Depression von 50–95 %, Werte, die von kaum einem therapeutischen Verfahren in der Medizin je erreicht werden [2]. In dieser Indikation wird die EKT in der DGPPN S3-Leitlinie für Depression bei höchstem Evidenzgrad nachhaltig empfohlen [3]. Aber auch bei anderen schwer zu beeinflussenden Störungsbildern wie katatoner Schizophrenie, malignem neuroleptischen Syndrom und bipolarer Störung bewirkt das Verfahren oft einen relevanten Symptomrückgang bzw. therapeutischen Durchbruch. Und obwohl die EKT mit zu den invasivsten Therapieverfahren im Fachgebiet der Psychiatrie rechnet, gilt sie gerade auch bei der aufgrund häufiger Multimorbidität „sensiblen” Patientenpopulation der über 65-jährigen an Depression erkrankten Klientel („Late life depression“) als bevorzugte Indikation, da sich auch hier bei überlegener Wirksamkeit ein besseres Verträglichkeitsprofil gegenüber einer im Individualfall erforderlichen Polypharmazie zeigt [4].

10.1055/a-0681-8928

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Deep brain stimulation for treatment-refractory obsessive compulsive disorder: a systematic review

BMC Psychiatry (2014)

Sina Kohl Deva M Schönherr Judy Luigjes Damiaan Denys Joerg Mueller

Obsessive-compulsive disorder is one of the most disabling of all psychiatric illnesses. Despite available pharmacological and psychotherapeutic treatments about 10% of patients remain severely affected and are considered treatment-refractory. For some of these patients deep brain stimulation offers an appropriate treatment method. The scope of this article is to review the published data and to compare different target structures and their effectiveness.PubMed search, last update June 2013, was conducted using the terms "deep brain stimulation" and "obsessive compulsive disorder".In total 25 studies were found that reported five deep brain stimulation target structures to treat obsessive-compulsive disorder: the anterior limb of the internal capsule (five studies including 14 patients), nucleus accumbens (eight studies including 37 patients), ventral capsule/ventral striatum (four studies including 29 patients), subthalamic nucleus (five studies including 23 patients) and inferior thalamic peduncle (two studies including 6 patients). Despite the anatomical diversity, deep brain stimulation treatment results in similar response rates for the first four target structures. Inferior thalamic peduncle deep brain stimulation results in higher response rates but these results have to be interpreted with caution due to a very small number of cases. Procedure and device related adverse events are relatively low, as well as stimulation or therapy related side effects. Most stimulation related side effects are transient and decline after stimulation parameters have been changed.Deep brain stimulation in treatment-refractory obsessive-compulsive disorder seems to be a relatively safe and promising treatment option. However, based on these studies no superior target structure could be identified. More research is needed to better understand mechanisms of action and response predictors that may help to develop a more personalized approach for these severely affected obsessive compulsive patients.

Subthalamic Nucleus

Ventral striatum

Brain stimulation

10.1186/s12888-014-0214-y

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Citations (104)