Abstract
IntroductionDeep brain stimulation (DBS) is a proven, effective tool in the treatment of movement disorders. Expansion of indications for DBS into the realm of neuropsychiatric disorders, especially obsessive–compulsive disorder (OCD), has gained fervent interest, although data on appropriate clinical utilization remains limited.MethodsA retrospective, naturalistic study followed nine severely affected OCD patients (average YBOCs score before implantation 34.2 ± 2.5) treated with DBS of ventral capsule/ventral striatum, with average follow up of 54.8 months.ResultsWith chronic stimulation (years), a majority of the patients achieved significant benefits in obsessive–compulsive and depressive symptoms. Six patients experienced periods of OCD remission following implantation. Four of the six responders required more than 12 months to achieve response. Relief of major depressive symptoms occurred in four out of six patients with documented co-morbid depression. Settings required to achieve efficacy were higher than those typically utilized for movement disorders, necessitating increased impulse generator (IPG) battery demand. We found patients benefited from conversion to a rechargeable IPG to prevent serial operations for IPG replacement. For patients with rechargeable IPGs, the repetitive habit of recharging did not appear to aggravate or trigger new obsessive–compulsive behaviors or anxiety symptoms.ConclusionsOur study supports and builds upon other research suggesting that DBS for OCD in a real-world setting can be implemented successfully and provide long-term benefit for severely affected OCD patients. Optimal patient selection and DBS programming criteria are discussed. The use of rechargeable IPGs appears to be both cost effective and well-tolerated in this population.
Highlights
Deep brain stimulation (DBS) is a proven, effective tool in the treatment of movement disorders
The University of Iowa (UI) has cared for a total of 9 patients with an implanted DBS system for treatment of obsessive–compulsive disorder (OCD) from January 2010 to January
Previous randomized controlled trials of VC/VS DBS in major depressive disorder (MDD) have demonstrated mixed results, our results suggest that comorbid MDD may be a good prognostic indicator for OCD patients getting VC/VS DBS [70, 76]
Summary
Deep brain stimulation (DBS) is a proven, effective tool in the treatment of movement disorders. Compulsive behaviors are frequently performed in an attempt to counteract obsessions and relieve the anxiety associated with them [1]. These behaviors can be time-consuming and create significant impairment in one or more areas of the patient’s life, interfering with his or her ability to live and function normally. Major depressive disorder is a common comorbidity [15] This combination of low mood with obsessions and compulsive behaviors leads to a high rate of suicide, and it is estimated that up to one quarter of patients with OCD will attempt suicide [16]
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