Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that arises from a complex interaction of environmental and genetic factors. Despite numerous pharmacological and behavioral interventions, approximately 10% of patients remain refractory. High-frequency deep brain stimulation (HF-DBS) has shown promising results for treatment-refractory OCD. We report the follow-up result of up to 6 years of 4 treatment-refractory OCD patients treated by HF-DBS. Targets of stimulation were the anterior limb of the internal capsule (ALIC) in two cases, and the nucleus accumbens (NAc) in the remaining cohort. The clinical profiles were quantified by the Yale-Brown obsessive-compulsive scale (Y-BOCS). Highly significant reductions in Y-BOCS scores were obtained from all patients during the follow-up period. A greater that 90% reduction in Y-BOCS, observed in the most successful case, was achieved with NAc HF-DBS. Y-BOCS scores in the other patients consistently achieved over 50% reductions in OCD symptoms. FDG-PET imaging indicated post-surgical reductions in metabolism, in not only targeted limbic networks, but also other frontal cortical and subcortical regions, suggesting that large-scale network modulation and inhibitions are associated with functional recovery in OCD. This study demonstrates that HF-DBS targeted to the ALIC and NAc is a safe and effective method for ameliorating intractable, treatment-refractory OCD symptoms. The NAc appeared to be the superior target for symptom reduction, and local inhibition of NAc activity and reduced frontal metabolism are key therapeutic indications.
Highlights
Obsessive-compulsive disorder (OCD) is one of the most disabling psychiatric illnesses; its emergence in patients is associated with intrusive thought and bizarre ritualistic behavioral patterns, which can lead to significant impairments in personal, social, and occupational function for those afflicted
We present the follow-up result of up to 6 years of 4 treatment-refractory OCD patients who underwent High-frequency deep brain stimulation (HF-DBS) of the nucleus accumbens (NAc) and anterior limb of the internal capsule (ALIC) for OCD based on intraoperative recording and long-term follow up with Fig 3. 18Fluorodeoxyglucose-positron emission tomography (FDG-PET)
S1, a nineteen-year-old male, was referred to Seoul National University Hospital (SNUH) OCD clinic for severe, refractory OCD accompanied with self-injurious behavior
Summary
Obsessive-compulsive disorder (OCD) is one of the most disabling psychiatric illnesses; its emergence in patients is associated with intrusive thought and bizarre ritualistic behavioral patterns, which can lead to significant impairments in personal, social, and occupational function for those afflicted. Substantial evidence supports the use of cognitive behavioral approaches and selective serotonin reuptake inhibitors (SSRIs) in the treatment of OCD [1]. Even after adequate treatment trials, 40% to 60% of patients endorse residual, impairing symptoms after initial treatment [2], prompting the investigation of augmentation strategies, novel pharmacologic agents, and neuromodulatory approaches. Consistent subset of patients, around 10%, remain refractory to any of the above treatment, and further treatment strategies are required [3]. Surgical treatments, including anterior cingulotomy, capsulotomy, subcaudate tractotomy, and limbic leucotomy, have been used for decades for patients with treatment-refractory OCD. The clinical response rate of these surgical treatments was reported to be 50% to 60% after 6–24 months [4]
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