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
> or =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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