Deep brain stimulation in obsessive-compulsive disorder – case report of two patients

Beszłej, Jan Aleksander; Siwicki, Damian; Fila-Witecka, Karolina; Wieczorek, Tomasz; Piotrowski, Patryk; Weiser, Artur; Tabakow, Paweł; Rymaszewska, Joanna

doi:10.12740/pp/104643

Cited by 7 publications

(7 citation statements)

References 19 publications

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“…Two patients even experienced rebound symptoms reporting HAM-A scores exceeding baseline levels by 39% and HAM-D scores by 36%. Similar results have been reported in two cases with a blinded discontinuation of DBS of the ALIC during the follow-up period (six months after DBS implementation) [27]. One of the two patients experienced a sudden increase (within a few hours) in anxiety, depression and frequency, as well as severity of OCD symptoms.…”

Section: Obsessive-compulsive Disorder (Ocd)supporting

confidence: 85%

“…Worsening of symptoms seems to be independent from stimulation target, although these effects have been researched more thoroughly in some targets than others. In OCD, discontinuation effects have been described for DBS of the VC [23,24], the ALIC [20,25,[27][28][29], the NAcc [26,31] and the STN [30]. Most studies as well as cases describing DBS cessation in TRD are reported for the stimulation of the SCG [16,33,34,37,39,40,43].…”

Section: Discussionmentioning

confidence: 99%

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Deep Brain Stimulation for Major Depression and Obsessive-Compulsive Disorder—Discontinuation of Ongoing Stimulation

Kilian

Bewernick

Klein

et al. 2020

Psych

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Deep brain stimulation (DBS) is currently under research for the treatment of psychiatric disorders, e.g., obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD). Since the application of DBS in psychiatry has been in use for about 20 years, it is necessary to evaluate its long-term use now. A main issue in the long-term treatment of DBS concerns the effects of a discontinuation of stimulation due to intended as well as unintended reasons. In this contribution, the literature describing discontinuation effects following DBS in OCD and TRD is reviewed. Furthermore, a patient is reported in depth who experienced an unintended discontinuation of supero-lateral medial forebrain bundle (slMFB) DBS for TRD. In this case, the battery was fully depleted without the patient noticing. DBS had led to a sustained response for seven years before discontinuation of stimulation for just several weeks caused a progressive worsening of depression. Altogether, the rapid occurrence of symptom worsening, the absence of a notification about the stimulation status and the difficulties to recapture antidepressant response represent important safety aspects. For a further understanding of the described effects, time courses until worsening of depression as well as biological mechanisms need to be investigated in double-blind controlled trials.

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Section: Obsessive-compulsive Disorder (Ocd)supporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation for Major Depression and Obsessive-Compulsive Disorder—Discontinuation of Ongoing Stimulation

Kilian

Bewernick

Klein

et al. 2020

Psych

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“…Our search strategy yielded a total of 3023 records (PubMed=841, EMBASE=2182) from 1986 to 2021. Thirty-four studies (n=352) from 2005 to 2021 were selected for systematic review and meta-analysis, including 9 RCTs (n=97)9 17 29–34 and 25 non-RCTs (n=255) 18–23 35–53. For more information on our search and selection process, see the PRISMA flow chart (figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…The most common described stimulation targets were VC/VS (six studies, n=63)18 35 37 40 52 55 and NAc (six studies, 53 patients)31 32 34 41 46 48 followed by ALIC (four studies, n=100),9 30 45 51 BNST (four studies, n=28),17 21 41 46 STN (three studies, n=47)29 44 53 and ALIC/BNST (three studies, n=37) 19 30 33. Other described target combinations included: NAc+VS+internal capsule (n=14),23 inferior thalamic peduncle (n=11),38 47 anteromedian STN+VC/VS (n=6),54 caudate nucleus (n=5),34 medial dorsal and ventral anterior nucleus of the thalamus (MD/VA) (n=4),42 superolateral branch of the medial forebrain bundle (n=2),43 STN+NAc (n=2),39 VS/ALIC (n=2),49 ALIC/NAc (n=2)50 and BNST/NAc (n=1) 46. Leads were implanted bilaterally in all cases except in one double-blind, sham-controlled RCT, which specifically targeted the right NAc (n=10).…”

Section: Resultsmentioning

confidence: 99%

Efficacy of deep brain stimulation for treatment-resistant obsessive-compulsive disorder: systematic review and meta-analysis

Gadot

Najera

Hirani

et al. 2022

J Neurol Neurosurg Psychiatry

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Deep brain stimulation (DBS) is an established and growing intervention for treatment-resistant obsessive-compulsive disorder (TROCD). We assessed current evidence on the efficacy of DBS in alleviating OCD and comorbid depressive symptoms including newly available evidence from recent trials and a deeper risk of bias analysis than previously available. PubMed and EMBASE databases were systematically queried using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We included studies reporting primary data on multiple patients who received DBS therapy with outcomes reported through the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Primary effect measures included Y-BOCS mean difference and per cent reduction as well as responder rate (≥35% Y-BOCS reduction) at last follow-up. Secondary effect measures included standardised depression scale reduction. Risk of bias assessments were performed on randomised controlled (RCTs) and non-randomised trials. Thirty-four studies from 2005 to 2021, 9 RCTs (n=97) and 25 non-RCTs (n=255), were included in systematic review and meta-analysis based on available outcome data. A random-effects model indicated a meta-analytical average 14.3 point or 47% reduction (p<0.01) in Y-BOCS scores without significant difference between RCTs and non-RCTs. At last follow-up, 66% of patients were full responders to DBS therapy. Sensitivity analyses indicated a low likelihood of small study effect bias in reported outcomes. Secondary analysis revealed a 1 standardised effect size (Hedges’ g) reduction in depressive scale symptoms. Both RCTs and non-RCTs were determined to have a predominantly low risk of bias. A strong evidence base supports DBS for TROCD in relieving both OCD and comorbid depression symptoms in appropriately selected patients.

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“…Stimulation of a person's internal capsule's anterior limb is a favored therapeutic approach for treating people with obsessive-compulsive disorder who are resistant to both medication and cognitive behavioral treatments [13]. Different studies have found significant effects of deep brain stimulation in the anterior limb of the brain's internal capsule [14][15][16][17]. Sun et al [18] reported improved capsulotomy results for treating refractory Tourette syndrome, with better effects being achieved when targeting the posterior portion of the anterior limb of patients' internal capsules as this section has greater white matter fibers projecting to the frontal cortex.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic radiofrequency thermocoagulation application in the anterior limbs of patients’ internal capsules in treating intractable tic disorders

Zhao

Wang

et al. 2020

International Journal of Hyperthermia

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Purpose: To investigate the effect of applying stereotactic radiofrequency thermocoagulation in the anterior limbs of patients' internal capsules in treating intractable tic disorders. Materials and methods: Patients diagnosed with intractable tic disorders were prospectively enrolled and treated using stereotactic radiofrequency thermocoagulation in the anterior limbs of the internal capsules. Periprocedural complications, effects, and follow-up outcomes were then analyzed. Results: Fifty patients were enrolled, including 38 with Tourette syndrome and 12 with persistent refractory vocal or motor tic disorders. The radiofrequency thermocoagulation procedure was performed successfully in all patients. Five participants (10%) experienced periprocedural complications, including one having a slight hemiplegia, two developing fevers (4%), and two developing urination disorders (4%). The participants underwent a follow-up for 12 months, with excellent effects being achieved in 23 patients (46%), prominent results in 13 (26%), good results in 10 (20%), and invalid results in 4 (8%), reaching an efficacy rate of 92% (46/50). Thirty-six patients experienced excellent and prominent effects, with no additional management after the radiofrequency ablation being needed, achieving a success rate of 72%. After radiofrequency thermocoagulation, the Yale Global Tic Severity Scale (YGTSS) scores were significantly reduced (p < .01) when compared with those before the procedure. Following this procedure, participants' serum dopamine levels (SDA) significantly decreased (p < .05), while their serotonin levels were significantly elevated (p < .05) when compared to the measurements taken before the procedure. Conclusion: Stereotactic radiofrequency thermocoagulation applied to the anterior limbs of patients' internal capsules may be effective for treating intractable tic disorders, without risk of serious complications.

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Deep brain stimulation in obsessive-compulsive disorder – case report of two patients

Cited by 7 publications

References 19 publications

Deep Brain Stimulation for Major Depression and Obsessive-Compulsive Disorder—Discontinuation of Ongoing Stimulation

Deep Brain Stimulation for Major Depression and Obsessive-Compulsive Disorder—Discontinuation of Ongoing Stimulation

Efficacy of deep brain stimulation for treatment-resistant obsessive-compulsive disorder: systematic review and meta-analysis

Stereotactic radiofrequency thermocoagulation application in the anterior limbs of patients’ internal capsules in treating intractable tic disorders

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