Abstract
Background: While case series have established the efficacy of deep brain stimulation (DBS) in treating obsessive-compulsive disorder (OCD), it has been our experience that few OCD patients present without comorbidities that affect outcomes associated with DBS treatment. Here we present our experience with DBS therapy for OCD in patients who all have comorbid disease, together with the results of our programming strategies.Methods: For this case series, we assessed five patients who underwent ventral capsule/ventral striatum (VC/VS) DBS for OCD between 2015 and 2019 at the University of Colorado Hospital. Every patient in this cohort exhibited comorbidities, including substance use disorders, eating disorder, tic disorder, and autism spectrum disorder. We conducted an IRB-approved, retrospective study of programming modifications and treatment response over the course of DBS therapy.Results: In addition to patients' subjective reports of improvement, we observed significant improvement in the Yale-Brown Obsessive-Compulsive Scale (44%), the Montgomery-Asberg Depression Rating Scale (53%), the Quality of Life Enjoyment and Satisfaction Questionnaire (27%), and the Hamilton Anxiety Rating scales (34.9%) following DBS. With respect to co-morbid disease, there was a significant improvement in a patient with tic disorder's Total Tic Severity Score (TTSS) (p = 0.005).Conclusions: DBS remains an efficacious tool for the treatment of OCD, even in patients with significant comorbidities in whom DBS has not previously been investigated. Efficacious treatment results not only from the accurate placement of the electrodes by the surgeon but also from programming by the psychiatrist.
Highlights
Obsessive-compulsive disorder (OCD) is a debilitating disorder characterized by obsessions and compulsions that afflicts ∼1.2% of people in the United States and between 1.1 and 1.8% worldwide [1]
The target was advanced by 3 mm after the identification of the direct target to allow for the space between contacts 0 and 1 to rest at the junction of the anterior limb of the internal capsule (ALIC) with the anterior limb of the anterior commissure (AC)
Despite persistent low BMI of 14, she has remained out of the hospital for 29 months, the longest time period since onset of OCD and anorexia. She is working part time as a research assistant, is active in her church, and, though she wishes for further reduction in symptoms, she notes her quality of life and mood is better than prior to deep brain stimulation (DBS)
Summary
Obsessive-compulsive disorder (OCD) is a debilitating disorder characterized by obsessions and compulsions that afflicts ∼1.2% of people in the United States and between 1.1 and 1.8% worldwide [1]. Compulsions are repetitive behaviors or mental “acts” (such as counting) that are performed to assuage distress or to prevent a feared event from happening. Many but not all compulsions make sense cognitively but consume far more time than they would for someone without OCD. There are five general subsets of symptoms within OCD, including contamination obsessions with washing/cleaning compulsions; harm obsessions with checking compulsions, obsessions without visible compulsions; symmetry obsessions with ordering, arranging, and counting compulsions, and hoarding [3]. While case series have established the efficacy of deep brain stimulation (DBS) in treating obsessive-compulsive disorder (OCD), it has been our experience that few OCD patients present without comorbidities that affect outcomes associated with DBS treatment. We present our experience with DBS therapy for OCD in patients who all have comorbid disease, together with the results of our programming strategies
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