Abstract
Obsessive-compulsive disorder (OCD) is a widespread chronic neuropsychiatric disorder characterized by recurrent intrusive thoughts, images, or urges (obsessions) that typically cause anxiety or distress. Even when optimal treatment is provided, 10% of patients remain severely affected chronically. In some countries, deep brain stimulation (DBS) is an approved and effective therapy for patients suffering from treatment-resistant OCD. Hereafter, we report the case of a middle-aged man with a long history of treatment-resistant OCD spanning nearly a decade with Yale–Brown Obsessive Compulsive Scale (Y-BOCS) scores oscillating between 21 and 28. The patient underwent bilateral implantation of ventral striatum/ventral capsule DBS leads attached to a battery-operated implanted pulse generator. After a 3-month postimplantation period, the DBS protocol started. Three months after the onset of DBS treatment, the patient's Y-BOCS score had dropped to 3, and he became steadily asymptomatic. However, inadvertently, at this time, it was found out that the implanted pulse generator battery had discharged completely, interrupting brain stimulation. The medical team carried on with the original therapeutic and evaluation plan in the absence of active DBS current. After 12 additional months under off-DBS, the patient remained at a Y-BOCS score of 7 and asymptomatic. To our knowledge, this is the first report that provides an opportunity to discuss four different hypotheses of long-term recovery induced by DBS in a treatment-refractory OCD patient, notably: (1) A placebo effect; (2) Paradoxical improvements induced by micro-lesions generated by DBS probe implantation procedures; (3) Unexpected late spontaneous improvements; (4) Recovery driven by a combination of active DBS-induction, the effects of medication, and DBS-placebo effects.
Highlights
Obsessive–compulsive disorder (OCD) is a widespread chronic neuropsychiatric disease characterized by recurrent intrusive thoughts, images, or urges that typically cause anxiety or distress
3 months after the theoretical onset of Deep brain stimulation (DBS) using the final set of fixed parameters reported earlier, the patient no longer complained of obsessive– compulsive disorder (OCD) symptoms, and his Yale–Brown Obsessive Compulsive Scale (Y-BOCS) fell to a score of 3
It is very unlikely that the achieved recovery might have been triggered “spontaneously” or could have occurred totally unrelated to the DBS procedures undergone as the ultimate therapeutic option
Summary
Obsessive–compulsive disorder (OCD) is a widespread chronic neuropsychiatric disease characterized by recurrent intrusive thoughts, images, or urges (obsessions) that typically cause anxiety or distress. 3 months after the theoretical onset of DBS using the final set of fixed parameters reported earlier, the patient no longer complained of OCD symptoms, and his Y-BOCS fell to a score of 3 He seemed soothed and did not feel the urge anymore for washing rituals, neither reported experiencing an insidious sense of contamination risk. Follow-up appointments were gradually spaced out, and 9 months post-lead implantation ( after 6 months of DBS treatment), the patient was asymptomatic and stable, still with a low Y-BOCS score of 3 At this time, during a routine check, the psychiatrist in charge of the study unexpectedly found out that the IPG was no longer operative because the battery had depleted completely long before. In January 2019, after a 12-month follow-up (Figure 3), the patient remained still stable and asymptomatic with a low Y-BOCS score of 7
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