Long-term efficacy of bilateral deep brain stimulation of the anterior limb of the internal capsule for refractory obsessive-compulsive disorder

Abstract

Objective To assess the long-term clinical efficacy of bilateral deep brain stimulation (DBS) of the anterior limb of the internal capsule (ALIC) for refractory obsessive-compulsive disorder (OCD). Methods Four patients with definite diagnosis of refractory OCD underwent bilateral DBS of ALIC at Department of Neurosurgery, Aviation General Hospital of China Medical University during the period from June 2010 to February 2012, and their clinical data were retrospectively analyzed. Symptoms were assessed according to the Yale-Brown obsessive compulsive scale (Y-BOCS), Hamilton depression rating scale (HAMD), Hamilton anxiety rating scale (HAMA), and personal and social performance scale (PSP) before and 6, 12, 36 months after operation. At the same time, all patients underwent PET-CT examination before surgery and 6 months after surgery, and the changes of metabolism in brain nuclei were evaluated. Results The 4 patients were followed up for 38-64 months (all beyond 36 months). The improvement rate was 25.0%-100.0% in terms of Y-BOCS score, 25.8%-100.0% in terms of HAMD score, and 27.3%-100.0% in terms of HAMA score. The PSP score indicated that the patients' personal and social functional activities improved significantly. The PET-CT examination suggested that brain structures with low metabolism assessed preoperatively demonstrated improvement with varying degrees at 6 months post surgery. In addition, the patients obtained significant improvement in terms of anxiety, depression and functional activities. None of the patients developed severe surgery-related complications. Conclusion Bilateral ALIC-DBS seems to be an effective and safe approach for the treatment of refractory OCD with minimal invasiveness, low rate of complications, benefits in anxiety and depression management and improvement of the patient's life quality. Key words: Obsessive-compulsive disorder; Anterior limb of the internal capsul; Deep brain stimulation; Prognosis