Jens Kuhn's research while affiliated with University Hospital Cologne and other places
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Publications (159)
When choosing between rewards that differ in temporal proximity (inter-temporal choice), human preferences are typically stable, constituting a clinically-relevant transdiagnostic trait. Here we show in female and male human patients undergoing deep brain stimulation (DBS) of the anterior limb of the internal capsule/nucleus accumbens region for tr...
The occurrence of tics in Tourette syndrome (TS) has often been linked to impaired cognitive control, but empirical findings are still inconclusive. A recent view proposes that tics may be the result of an abnormally strong interrelation between perceptual processes and motor actions, commonly referred to as perception-action binding. The general a...
Impulsivity is a multidimensional, cross-diagnostic behavioural construct that has been described in various psychiatric disorders including obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). Different interpretations of results in the past have raised the question of heightened impulsivity as an explanatory model for self-described im...
Treatment resistance in alcohol use disorders (AUD) is a major problem for affected individuals and for society. In the search of new treatment options, few case studies using deep brain stimulation (DBS) of the nucleus accumbens have indicated positive effects in AUD. Here we report a double-blind randomized controlled trial comparing active DBS (...
Background: Deep brain stimulation of the anterior limb of the internal capsule/nucleus accumbens (ALIC/NAc) is an effective treatment in patients with obsessive-compulsive disorder but may increase impulsive behavior. We aimed to investigate how active stimulation alters subdomains of impulsive decision-making and whether respective effects depend...
Self-injurious behavior (SIB) is associated with diverse psychiatric conditions. Sometimes (e.g., in patients with autism spectrum disorder or acquired brain injuries), SIB is the most dominant symptom, severely restricting the psychosocial functioning and quality of life of the patients and inhibiting appropriate patient care. In severe cases, it...
Deep brain stimulation is an effective treatment for obsessive–compulsive disorder but is rarely used. Action is needed by psychologists, psychiatrists and insurers so that patients with otherwise intractable cases can receive this therapy to improve their mental health.
Seit über zwei Jahren ist die weltweite Bevölkerung der Pandemie mit dem SARS-CoV-2-Virus ausgesetzt. Die damit verbundene primäre Krankheitslast, also durch Infektionen, war und ist enorm. Sekundäre Belastungen ergaben sich durch Sorgen um die eigene und die Gesundheit enger Bezugspersonen, Trauerreaktionen im Falle des infektionsbedingten Verlust...
Deep brain stimulation (DBS) for Tourette syndrome (TS) is an evolving therapy for severely affected patients. However, there is still ambiguity about the ideal target and networks that need to be modulated for optimal results. Recently, Johnson et al. demonstrated that tic reductions depend on normative structural connectivity seeding from stimula...
This scientific commentary refers to ‘A brain network for deep brain stimulation induced cognitive decline in Parkinson’s disease’ by Reich et al. (https://doi.org/10.1093/brain/awac012).
In 2011 the European Society for the Study of Tourette Syndrome (ESSTS) published its first European clinical guidelines for the treatment of Tourette Syndrome (TS) with part IV on deep brain stimulation (DBS). Here, we present a revised version of these guidelines with updated recommendations based on the current literature covering the last decad...
ZUSAMMENFASSUNG
Hintergrund Bei Patienten mit Störungen aus dem schizophrenen Formenkreis ist der Konsum von Cannabis und anderen psychoaktiven Substanzen weit verbreitet. Es besteht eine wissenschaftliche Evidenz, dass der hochdosierte und regelmäßige Freizeitkonsum von Cannabis mit nachteiligen Langzeitfolgen assoziiert ist. Und dennoch könnte di...
Introduction:
Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation (rTMS) offer a promising alternative to psychotherapeutic and pharmacological treatments for depression. This paper aims to present a practical guide for its clinical implementation based on evidence from the literature as well as on the ex...
Introduction Several psychiatric and somatic medications are assumed to improve COVID-19-symptoms. These include antidepressants, antipsychotics, and anticonvulsants as well as anticoagulants, statins, and renin-angiotensin-aldosterone-system (RAAS)-inhibitors for somatic comorbid conditions. All these agents may reduce the hyperinflammatory respon...
Background
Deep brain stimulation (DBS) of the medial thalamus is an evolving therapy for severe, treatment-refractory Tourette syndrome (TS). It remains unanswered which functionally connected networks need to be modulated to obtain optimal treatment results.
Methods
We assessed treatment response of 15 patients with TS untergoing thalamic DBS si...
Obsessive-compulsive disorder is among the most disabling psychiatric disorders. Although deep brain stimulation is considered an effective treatment, its use in clinical practice is not fully established. This is, at least in part, due to ambiguity about the best suited target and insufficient knowledge about underlying mechanisms.
Recent advances...
Objectives
Obsessive–compulsive disorder (OCD) is a psychiatric disorder with alterations of cortico-striato-thalamo-cortical loops and impaired performance monitoring. Electrophysiological markers such as conflict-related medial frontal theta (MFT) and error-related negativity (ERN) may be altered by clinically effective deep brain stimulation (DB...
Background
There is still a lack of controlled studies to prove efficacy of thalamic deep brain stimulation for Tourette's Syndrome.
Objectives
In this controlled trial, we investigated the course of tic severity, comorbidities and quality of life during thalamic stimulation and whether changes in tic severity can be assigned to ongoing compared t...
Tourette syndrome is a neurodevelopmental disorder associated with hyperactivity in dopaminergic networks. Dopaminergic hyperactivity in the basal ganglia has previously been linked to increased sensitivity to positive reinforcement and increases in choice impulsivity. In this study, we examine whether this extends to changes in temporal discountin...
ZUSAMMENFASSUNG
Patienten mit Schizophrenie sind durch Positiv- und Negativsymptomatik, aber auch durch kognitive Störungen in ihrer Lebensqualität und Alltagsfunktionalität beeinträchtigt. Nach dem Abklingen der psychotischen Akutsymptomatik können persistierende kognitive und funktionelle Defizite ein eigenständiges Leben und den Weg zurück an de...
Background: Symptoms of obsessive-compulsive disorder (OCD) are partly related to impaired cognitive control processes and theta modulations constitute an important electrophysiological marker for cognitive control processes such as signaling negative performance feedback in a fronto-striatal network. Deep brain stimulation (DBS) targeting the ante...
Background: Multiple deep brain stimulation (DBS) targets have been proposed for treating intractable obsessive-compulsive disorder (OCD). Here, we investigated whether stimulation effects of different target sites would be mediated by one common or several segregated functional brain networks.
Methods: Seeding from active electrodes of four patien...
Background: In response to the COVID-19-pandemic, a lockdown was established in the middle of March 2020 by the German Federal Government resulting in drastic reduction of private and professional traveling in and out of Germany with a reduction of social contacts in public areas.
Research Questions: We seek evidence on whether the lockdown has led...
Zusammenfassung
Hintergrund In Europa gab es in den letzten 15 Jahren mehrere Schädlichkeits-Vergleiche bezüglich der Einnahme von psychotropen Substanzen durch Suchtexperten. Eine einzige Einschätzung liegt bezüglich des potenziellen Nutzens vor. Non-Opioiderge Analgetika (NOA), wie Gabapentinoide und NSARs, die zunehmend Gegenstand von Missbrauch...
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 p...
![Figure 2. Reliability of inter-temporal choice (discount rate log[k])....](profile/Ben-Wagner/publication/347256235/figure/fig2/AS:969053162176512@1608051686154/Reliability-of-inter-temporal-choice-discount-rate-logk-a-and-b-show-individual_Q320.jpg)
When choosing between rewards that differ in temporal proximity (inter-temporal choice), human preferences are typically stable, constituting a clinically-relevant transdiagnostic trait. Here we show in patients undergoing deep brain stimulation (DBS) of the anterior limb of the internal capsule / nucleus accumbens region for treatment-resistant ob...
Background: Over the past 15 years, comparative assessments of psychoactive substance harms to both users and others have been compiled by addiction experts. None of these rankings however have included synthetic cannabinoids or non-opioid prescription analgesics (NOAs, e.g., gabapentinoids) despite evidence of increasing recreational use. We prese...
Recent translational data suggest that deep brain stimulation (DBS) of the cortico-striato-thalamo-cortical (CSTC) loops improves sensorimotor gating in psychiatric disorders that show deficient prepulse inhibition (PPI), a robust operational measure of sensorimotor gating. To our knowledge we are the first to investigate this effect in patients wi...
Deep brain stimulation may be an effective therapy for select cases of severe, treatment-refractory Tourette syndrome; however, patient responses are variable, and there are no reliable methods to predict clinical outcomes. The objectives of this retrospective study were to identify the stimulation-dependent structural networks associated with impr...
Multiple surgical targets for treating obsessive-compulsive disorder with deep brain stimulation (DBS) have been proposed. However, different targets may modulate the same neural network responsible for clinical improvement. We analyzed data from four cohorts of patients (N = 50) that underwent DBS to the anterior limb of the internal capsule (ALIC...
Closed-loop neuromodulation is presumed to be the logical evolution for improving the effectiveness of deep brain stimulation (DBS) treatment protocols [1]. Identifying symptom-relevant biomarkers that provide meaningful feedback to stimulator devices is an important initial step in this direction. This report demonstrates a technique for assaying...
Closed-loop neuromodulation is presumed to be the logical evolution for improving the effectiveness of deep brain stimulation (DBS) treatment protocols [1]. Identifying symptom-relevant biomarkers that provide meaningful feedback to stimulator devices is an important initial step in this direction. This report demonstrates a technique for assaying...
This scientific commentary refers to ‘Deep brain stimulation modulates directional limbic connectivity in obsessive-compulsive disorder’, by Fridgeirsson etal. (doi:10.1093/brain/awaa100).
Background
Tourette syndrome is a neurodevelopmental disorder with the clinical hallmarks of motor and phonic tics which are associated with hyperactivity in dopaminergic networks. Dopaminergic hyperactivity in the basal ganglia has previously been linked to increased sensitivity to positive reinforcement and increases in choice impulsivity.
Objec...
Objective:
Tourette syndrome is a neurodevelopmental disorder putatively associated with a hyperdopaminergic state. Therefore, it seems plausible that excessive dopamine transmission in Tourette syndrome alters the ability to learn based on rewards and punishments. We tested whether Tourette syndrome patients exhibited altered reinforcement learni...
Weight changes are insufficiently understood adverse events of deep brain stimulation. In this context, exploring neural networks of weight control may inform novel treatment strategies for weight-related disorders. In this study, we investigated weight changes after deep brain stimulation of the ventral striatum/ventral capsule and to what extent...
To the Editor In their cohort study, Brander et al¹ observed an increased risk of metabolic and cardiovascular diseases in patients with Tourette syndrome (TS) and chronic tic disorder. This risk was even higher in patients with comorbid attention-deficit/hyperactivity disorder. Interestingly, metabolic and cardiovascular risks were already present...
Background:
Programming algorithms have never been tested for outcome. The EARLYSTIM study showed superior outcomes of deep brain stimulation of the subthalamic nucleus (STN-DBS) over best medical treatment in early Parkinson's disease (PD). Patients were programmed according to common guidelines but customized for each patient.
Methods:
Stimula...
Background
Deep brain stimulation (DBS) can be an effective therapy for tics and comorbidities in select cases of severe, treatment-refractory Tourette syndrome (TS). Clinical responses remain variable across patients, which may be attributed to differences in the location of the neuroanatomical regions being stimulated. We evaluated active contact...
Since its first application in 1999, the potential benefit of Deep Brain Stimulation (DBS) in reducing symptoms of otherwise treatment-refractory Tourette syndrome has been documented in several publications. However, there is still a lack of controlled studies to prove efficacy.
In this single-center trial at the University Hospital of Cologne, 8...
Background: Deep brain stimulation for obsessive-compulsive disorder is a rapidly developing treatment strategy for treatment-refractory patients. Both the exact target and impact on distributed brain networks remain a matter of debate. Here, we investigated which regions connected to stimulation sites contribute to clinical improvement effects and...
Background: Deep brain stimulation for obsessive-compulsive disorder is a rapidly developing treatment strategy for treatment-refractory patients. Both the exact target and impact on distributed brain networks remain a matter of debate. Here, we investigated which regions connected to stimulation sites contribute to clinical improvement effects and...
Multiple surgical targets have been proposed for treating obsessive-compulsive disorder (OCD) with Deep brain stimulation (DBS). However, different targets may lie along the same fiber bundle, which could be responsible for clinical improvement. Here we analyzed data from two cohorts of OCD patients that underwent DBS to either the anterior limb of...
„Motivational interviewing“ (MI; motivierende Gesprächsführung) hat sich als Ansatz für einen kooperativen Gesprächsstil zur Förderung intrinsischer Veränderungsmotivation durch Erkundung und Auflösen von Ambivalenzen etabliert. Die Veränderung von Suchtverhalten wird nicht mehr durch Ausüben von Druck oder belehrenden/bekehrenden Überzeugungs- bzw...
Zusammenfassung
Die notwendige Behandlungskontinuität von Patienten mit Erkrankungen aus dem schizophrenen Formenkreis wird durch die Sektorisierung der Gesundheitsversorgung in Deutschland und den daraus erwachsenden Schnittstellenproblemen und Versorgungslücken erheblich beeinträchtigt. Die vorliegende Arbeit gibt eine Übersicht zur medizinischen...
Background
For more than 15 years, deep brain stimulation (DBS) has served as a last-resort treatment for severe treatment-resistant obsessive-compulsive disorder (OCD).
Methods
From 2010 to 2016, 20 patients with OCD (10 men/10 women) were included in a single-centre trial with a naturalistic open-label design over 1 year to evaluate the effects...
Background: Delay discounting (DD) describes the phenomenon of devaluing future rewards in favor of immediate rewards. Increased DD is a key behavioral marker of addiction, and has been suggested as a target for interventions to alleviate addiction symptoms (e.g., preference for immediate drug use over larger-and-later rewards, and relapses) in pat...
Zusammenfassung
Die Berücksichtigung der Lebensqualität hat sich in den in den letzten 50 Jahren zu einem wichtigen Konzept einer patientenorientierten Medizin entwickelt. Mit ihm soll das subjektive Erleben der Patienten erfassbar und in seinen verschiedenen Dimensionen beschreibbar gemacht werden. Heute ist die Lebensqualität als patientenbericht...
Objective: Epigenetic mechanisms have been described in several mental disorders, such as mood disorders, anxiety disorders and schizophrenia. However, less is known about the influence of epigenetic mechanisms with regard to personality disorders (PD). Therefore, we conducted a literature review on existing original data with regards to epigenetic...
Tourette syndrome (TS) is a complex neurodevelopment disorder characterized by involuntary movements and vocalizations, or tics. It is commonly associated with obsessive-compulsive behavior (OCB). Deep brain stimulation (DBS) has been explored as a potential therapy for select cases of TS with severe, treatment-refractory symptoms. Several nuclei h...
Objective:
Whether motor inhibition capabilities are impaired in Tourette's syndrome (TS) remains inconclusive. The ability to suppress tics has been proposed to ensure normal motor control in uncomplicated, adult patients. The aim of the present study was to characterize cortical processes of motor inhibition and performance monitoring using even...
Background:
Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving...
Agitation is a heterogeneous concept without a uniformly accepted definition, however,
it is generally considered as a state of cognitive and motor hyperactivity characterized
by excessive or inappropriate motor or verbal activity with marked emotional arousal.
Not only the definition but also other aspects of agitated patients’ care are still unso...
Deep brain stimulation (DBS) of the nucleus accumbens (NAc) shows first promising results in patients with severe substance use disorder (SUD), a patient group known to have deficits in self-control. One facet of self-control is the ability to forego smaller sooner rewards in favor of larger later rewards (delay discounting, DD). The NAc has been s...
Importance
Collective evidence has strongly suggested that deep brain stimulation (DBS) is a promising therapy for Tourette syndrome.
Objective
To assess the efficacy and safety of DBS in a multinational cohort of patients with Tourette syndrome.
Design, Setting, and Participants
The prospective International Deep Brain Stimulation Database and R...
Background:
Deep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG) is an experimental approach in treatment-resistant depression (TRD). Short-term results of efficacy in DBS are incongruent and studies investigating long-term effects are warranted.
Methods:
We assessed efficacy of SCG-DBS in eight patients randomized into a delaye...
Alzheimer′s disease (AD) is associated with deterioration of memory and cognitive function and a degeneration of neurons of the nucleus basalis of Meynert (NBM). The NBM is the major input source of Acetylcholine (ACh) to the cortex. The decreasing cholinergic innervation of the cortex due to degeneration of the NBM might be the cause of loss of me...
To the Editor The review by Dr Hirschtritt and colleagues¹ gave a comprehensive overview of diagnosis and treatment of obsessive-compulsive disorder (OCD). The authors proposed deep-brain stimulation as a treatment option for severely affected and treatment-resistant patients. They referred to a meta-analysis stating that 60% of patients respond to...
Objectives:
First reports on the application of deep brain stimulation (DBS) of the Nucleus basalis of Meynert (NBM) showed feasibility and safety of the intervention in patients with Alzheimer´s disease. However, clinical effects vary and the mechanisms of actions are still not well understood. The aim of this study was to characterize neuroimagi...
Gilles de la Tourette syndrome is a complex,
idiopathic neuropsychiatric disorder whose pathophysiological
mechanisms have yet to be elucidated. It is phenotypically
heterogeneous and manifests more often than
not with both motor and behavioral impairment, although
tics are its clinical hallmark. Tics themselves present with a
complex profile as th...
Gilles de la Tourette’s syndrome (TS) is an idiopathic neuropsychiatric
disorder with an unknown etiology affecting approximately
1% of the population.1 Diagnosis is based on the childhood
onset of chronic involuntary motor and phonic tics that are not
attributable to drugs or known medical causes and persist for no
less than 1 cumulative year.2-4...
Gilles de la Tourette syndrome is a complex,
idiopathic neuropsychiatric disorder whose pathophysiological
mechanisms have yet to be elucidated. It is phenotypically
heterogeneous and manifests more often than
not with both motor and behavioral impairment, although
tics are its clinical hallmark. Tics themselves present with a
complex profile as th...
Background:
The current notion that cortico-striato-thalamo-cortical circuits are involved in the pathophysiology of obsessive-compulsive disorder (OCD) has instigated the search for the most suitable target for deep brain stimulation (DBS). However, despite extensive research, uncertainty about the ideal target remains with many structures being...
Statement of the Ethics Committee.
(PDF)