Abstract
Deep brain stimulation (DBS) of the anterior limb of the internal capsule has been shown to be beneficial in the short term for obsessive–compulsive disorder (OCD) patients who exhaust conventional therapies. Nuttin et al, who published the first DBS for OCD series, found promising results using a capsule target immediately rostral to the anterior commissure extending into adjacent ventral capsule/ventral striatum (VC/VS). Published long-term outcome data are limited to four patients. In this collaborative study, 10 adult OCD patients meeting stringent criteria for severity and treatment resistance had quadripolar stimulating leads implanted bilaterally in the VC/VS. DBS was activated openly 3 weeks later. Eight patients have been followed for at least 36 months. Group Yale-Brown Obsessive Compulsive Scale (YBOCS) scores decreased from 34.6±0.6 (mean±SEM) at baseline (severe) to 22.3±2.1 (moderate) at 36 months (p<0.001). Four of eight patients had a ⩾35% decrease in YBOCS severity at 36 months; in two patients, scores declined between 25 and 35%. Global Assessment of Functioning scores improved from 36.6±1.5 at baseline to 53.8±2.5 at 36 months (p<0.001). Depression and anxiety also improved, as did self-care, independent living, and work, school, and social functioning. Surgical adverse effects included an asymptomatic hemorrhage, a single seizure, and a superficial infection. Psychiatric adverse effects included transient hypomanic symptoms, and worsened depression and OCD when DBS was interrupted by stimulator battery depletion. This open study found promising long-term effects of DBS in highly treatment-resistant OCD.
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Acknowledgements
This work was supported by an Independent Investigator Award from the National Alliance for Research on Schizophrenia and Depression (BDG, SAR); The National Institute of Mental Health (MSO and WKG); and research funding from Medtronic Inc. (BDG, SAR, GMF, DAM, ARR). We thank Bart Nuttin, Volker Sturm, Doris Lenartz, Kelly Foote, Andre Machado, and Robert Gross for consultations on neurosurgical issues; Loes Gabriels, Paul Cosyns, NA Shapira, Anthony Grace, and Erwin Montgomery for consultations on electrical stimulation and clinical issues in this population; Paul Stypulkowski, Mark Rise, and Roy Testerman for technical advice on the DBS devices; William Wong, Ronald Gaertner, and Richard Marsland for invaluable assistance in patient care; Suzanne Haber, Scott Rauch, and Darin Dougherty for discussions of neurocircuitry and neurosurgery in this population; and Rouba Youssef, Katherine Rowinski, Erin Einbinder, and Natalie Sykuta for help with data management and analysis.
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Greenberg, B., Malone, D., Friehs, G. et al. Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder. Neuropsychopharmacol 31, 2384–2393 (2006). https://doi.org/10.1038/sj.npp.1301165
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DOI: https://doi.org/10.1038/sj.npp.1301165
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