Deep Brain Stimulation of the Nucleus Accumbens for Treatment-Refractory Obsessive-Compulsive Disorder

Denys, Damiaan; Mantione, Mariska; Figee, Martijn; Munckhof, Pepijn van den; Koerselman, Frank; Westenberg, H.G.M.; Bosch, Andries; Schuurman, Rick

doi:10.1001/archgenpsychiatry.2010.122

Cited by 649 publications

(540 citation statements)

References 20 publications

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“…Owing to symptom aggravation and delayed recurrence as well as weaker antidepressant effect, the design was changed leaving out the sham condition. These problems have been reported also by Holtzheimer et al (2012) during a single-blind discontinuation phase in therapy-resistant depression and by Denys et al (2010) in patients suffering from obsessive-compulsive disorder. This is a strong limitation in respect to placebo effects.…”

Section: Limitationsmentioning

confidence: 64%

Long-Term Effects of Nucleus Accumbens Deep Brain Stimulation in Treatment-Resistant Depression: Evidence for Sustained Efficacy

Bewernick

Kayser

Sturm

et al. 2012

Neuropsychopharmacol

317

198

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Deep brain stimulation (DBS) to the nucleus accumbens (NAcc-DBS) was associated with antidepressant, anxiolytic, and procognitive effects in a small sample of patients suffering from treatment-resistant depression (TRD), followed over 1 year. Results of long-term follow-up of up to 4 years of NAcc-DBS are described in a group of 11 patients. Clinical effects, quality of life (QoL), cognition, and safety are reported. Eleven patients were stimulated with DBS bilateral to the NAcc. Main outcome measures were clinical effect (Hamilton Depression Rating Scale, Montgomery-Asperg Rating Scale of Depression, and Hamilton Anxiety Scale) QoL (SF-36), cognition and safety at baseline, 12 months (n ¼ 11), 24 months (n ¼ 10), and last follow-up (maximum 4 years, n ¼ 5). Analyses were performed in an intent-to-treat method with last observation carried forward, thus 11 patients contributed to each point in time. In all, 5 of 11 patients (45%) were classified as responders after 12 months and remained sustained responders without worsening of symptoms until last follow-up after 4 years. Both ratings of depression and anxiety were significantly reduced in the sample as a whole from first month of NAcc-DBS on. All patients improved in QoL measures. One non-responder committed suicide. No severe adverse events related to parameter change were reported. First-time, preliminary long-term data on NAcc-DBS have demonstrated a stable antidepressant and anxiolytic effect and an amelioration of QoL in this small sample of patients suffering from TRD. None of the responders of first year relapsed during the observational period (up to 4 years).

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Section: Limitationsmentioning

confidence: 64%

Long-Term Effects of Nucleus Accumbens Deep Brain Stimulation in Treatment-Resistant Depression: Evidence for Sustained Efficacy

Bewernick

Kayser

Sturm

et al. 2012

Neuropsychopharmacol

317

198

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“…There has also been 1 report suggesting that patients with more egosyntonic obsessive-compulsive symptoms benefit less from DBS. In this report, 14 4 patients experiencing perfectionism, need for symmetry, seeking reassurance, and hoarding symptoms had mean Y-BOCS reductions of 10% after stimulation in the nucleus accumbens for 32 weeks, while the entire sample of 16 patients had mean Y-BOCS reductions of 46%, including 9 patients without these symptoms in which the reduction was greater than 50%. Although still tentative, correlations between patterns of obsessive-compulsive symptoms and surgical outcome (using different brain targets) could not only improve surgical protocols, but also provide more direct evidence to support the assumption that symptom dimensions are individually associated with distinct neurobiological substrates.…”

mentioning

confidence: 64%

“…deep-brain stimulation (DBS) 1,[6][7][8]12,18,22,23,31,51 for treatment-refractory OCD published in the last 10 years did not provide information on symptom dimensions, while 6 ablative 25,28 and DBS 14,20,21,54 studies described or commented on obsessive-compulsive symptom characteristics, and only 2 studies actively investigated the association of symptom dimensions with clinical outcome. 44,47 The first study, published by Rück and colleagues in 2012, 44 used an algorithm to calculate symptom dimensions based on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist (Y-BOCS-SC), 19 and reported that patients with prominent symmetry/order and/or hoarding symptoms were less likely to benefit from anterior capsulotomy.…”

mentioning

confidence: 99%

Hoarding symptoms and prediction of poor response to limbic system surgery for treatment-refractory obsessive-compulsive disorder

Gentil

Lopes

Dougherty

et al. 2014

JNS

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Object Recent findings have suggested a correlation between obsessive-compulsive disorder (OCD) symptom dimensions and clinical outcome after limbic system surgery for treatment-refractory patients. Based on previous evidence that the hoarding dimension is associated with worse outcome in conventional treatments, and may have a neural substrate distinct from OCD, the authors examined a large sample of patients undergoing limbic surgery (40 with capsulotomy, 37 with cingulotomy) and investigated if symptom dimensions, in particular hoarding, could influence treatment outcome. Methods Data from 77 patients from 3 different research centers at São Paulo (n = 17), Boston (n = 37), and Stockholm (n = 23) were analyzed. Dimensional Yale-Brown Obsessive Compulsive Scale (Y-BOCS; São Paulo) or Y-BOCS Symptom Checklist scores (Boston and Stockholm) were used to code the presence of 4 well-established symptom dimensions: forbidden thoughts, contamination/cleaning, symmetry/order, and hoarding. Reductions in YBOCS scores determined clinical outcome. Results Mean Y-BOCS scores decreased 34.2% after surgery (95% CI 27.2%–41.3%), with a mean follow-up of 68.1 months. Patients with hoarding symptoms had a worse response to treatment (mean Y-BOCS decrease of 22.7% ± 25.9% vs 41.6% ± 32.2%, respectively; p = 0.006), with no significant effect of surgical modality (capsulotomy vs cingulotomy). Patients with forbidden thoughts apparently also had a worse response to treatment, but this effect was dependent upon the co-occurrence of the hoarding dimension. Only the negative influence of the hoarding dimension remained when an ANOVA model was performed, which also controlled for preoperative symptom severity. Conclusions The presence of hoarding symptoms prior to surgery was associated with worse clinical outcome after the interventions. Patients with OCD under consideration for ablative surgery should be carefully screened for hoarding symptoms or comorbid hoarding disorder. For these patients, the potentially reduced benefits of surgery need to be carefully considered against potential risks.

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“…Specifically, high-dose olanzapine [522], quetiapine [523], and risperidone [524] have all shown at least minimal clinical benefit relative to placebo treatment [525]. Finally, reports that the ventral striatum is an effective target for deep brain-stimulation treatment in OCD, particularly in patients identified as otherwise treatment-resistant, further implicates the mesolimbic DA system in OCD [526-528]. …”

Section: Reviewmentioning

confidence: 99%

Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings

Dichter

Damiano

Allen

2012

J Neurodevelop Disord

254

207

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This review summarizes evidence of dysregulated reward circuitry function in a range of neurodevelopmental and psychiatric disorders and genetic syndromes. First, the contribution of identifying a core mechanistic process across disparate disorders to disease classification is discussed, followed by a review of the neurobiology of reward circuitry. We next consider preclinical animal models and clinical evidence of reward-pathway dysfunction in a range of disorders, including psychiatric disorders (i.e., substance-use disorders, affective disorders, eating disorders, and obsessive compulsive disorders), neurodevelopmental disorders (i.e., schizophrenia, attention-deficit/hyperactivity disorder, autism spectrum disorders, Tourette’s syndrome, conduct disorder/oppositional defiant disorder), and genetic syndromes (i.e., Fragile X syndrome, Prader–Willi syndrome, Williams syndrome, Angelman syndrome, and Rett syndrome). We also provide brief overviews of effective psychopharmacologic agents that have an effect on the dopamine system in these disorders. This review concludes with methodological considerations for future research designed to more clearly probe reward-circuitry dysfunction, with the ultimate goal of improved intervention strategies.

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Deep Brain Stimulation of the Nucleus Accumbens for Treatment-Refractory Obsessive-Compulsive Disorder

Abstract: isrctn.org Identifier: ISRCTN23255677.

Cited by 649 publications

References 20 publications

Long-Term Effects of Nucleus Accumbens Deep Brain Stimulation in Treatment-Resistant Depression: Evidence for Sustained Efficacy

Long-Term Effects of Nucleus Accumbens Deep Brain Stimulation in Treatment-Resistant Depression: Evidence for Sustained Efficacy

Hoarding symptoms and prediction of poor response to limbic system surgery for treatment-refractory obsessive-compulsive disorder

Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings

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