A Randomized Trial Directly Comparing Ventral Capsule and Anteromedial Subthalamic Nucleus Stimulation in Obsessive-Compulsive Disorder: Clinical and Imaging Evidence for Dissociable Effects.

Himanshu Tyagi,Keith Matthews,Patricia Limousin,Eileen M Joyce,Lynne M Drummond,Naomi A Fineberg,Annemieke M Apergis-Schoute,Harith Akram,Barbara J Sahakian,Marjan Jahanshahi,Trevor W Robbins,Marwan Hariz,Ludvic Zrinzo,Tom Foltynie

doi:10.1176/appi.focus.20105

Himanshu Tyagi, Keith Matthews + Show 12 more

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https://doi.org/10.1176/appi.focus.20105

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(Appeared originally in Biological Psychiatry 2019; 85:726-734) Reprinted under Creative Commons CC-BY license.

Highlights

Deep brain stimulation (DBS) is an emerging treatment for severe obsessive-compulsive disorder (OCD)
DBS at each site significantly and equivalently reduced OCD symptoms with little additional gain following combined stimulation. anteromedial subthalamic nucleus (amSTN) but not VC/VS DBS significantly improved cognitive flexibility, whereas VC/VS DBS had a greater effect on mood
In this study, using a randomized, double-blind, counterbalanced design, we investigated the effects of VC/VS and amSTN DBS in the same patients to 1) establish whether one site is more efficacious than the other in improving OCD, 2) determine the precise neuroanatomical locations for optimal effects by calculating volumes of tissue activation (VTAs) at each site, and 3) test the hypothesis of Denys et al [7] by first employing ratings of mood and a test of cognitive flexibility previously shown to measure an endophenotype of OCD [11] and investigating the neural circuitry associated with the DBS at each site with magnetic resonance imaging (MRI) tractography

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Introduction

Deep brain stimulation (DBS) is an emerging treatment for severe obsessive-compulsive disorder (OCD). METHODS: Six patients with treatment-refractory OCD (5 men; Yale-Brown Obsessive Compulsive Scale score .32) entered double-blind counterbalanced phases of 12-week amSTN or VC/VS DBS, followed by 12-week open phases when amSTN and VC/VS were stimulated together, in which optimal stimulation parameters were achieved and adjunctive inpatient cognitive behavioral therapy was delivered. AmSTN but not VC/VS DBS significantly improved cognitive flexibility, whereas VC/VS DBS had a greater effect on mood. No further improvement followed cognitive behavioral therapy, reflecting a floor effect of DBS on OCD. Differential improvements in mood and cognitive flexibility and their associated connectivity suggest that DBS at these sites modulates distinct brain networks

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