Modeling impulsivity and risk aversion in the subthalamic nucleus with deep brain stimulation.
Nature. Mental health, ISSN: 2731-6076, Vol: 2, Issue: 9, Page: 1084-1095
2024
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Deep brain stimulation study models impulsivity and risk aversion
Deep brain stimulation (DBS) is a neurosurgical procedure that entails the implantation of electrodes in specific brain regions, to subsequently stimulate these regions via high
Article Description
Risk evaluation is ubiquitous in decisions. Deep brain stimulation of the subthalamic nucleus is effective for Parkinson's disease and obsessive-compulsive disorder, and can be associated with impulsivity and hypomania. Subthalamic stimulation has seemingly contrasting effects on impulsivity enhancing conflict-induced impulsivity but decreasing risk taking. Here, using a card gambling task paired with intracranial recordings ( = 25) and within-subject case control acute stimulation ( = 15) of the right subthalamic nucleus, we dissociated objective risk and uncertainty and subjective physiological markers of risk. Acute stimulation decreased risk taking ( = 0.010, Cohen's = 0.72) and increased subthalamic theta activity ( < 0.001, Cohen's = 0.72). Critically, stimulation negatively shifted the relationship between subthalamic physiology and a measure of evidence accumulation similar to observations with stimulation-induced conflict processing. This highlights the phenotypic and physiological heterogeneity of impulsivity, yet linking mechanisms underlying stimulation-induced conflict and risk. Finally, stimulation-induced risk seeking implicates the ventral subthalamic nucleus and dissociating anatomical and functional connectivity with the mesial prefrontal cortex. Our findings have implications for conceptualizations of impulsivity, and clinical relevance for neuropsychiatric disorders.
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