Deep Brain Stimulation of the Nucleus Accumbens and Bed Nucleus of Stria Terminalis for Obsessive-Compulsive Disorder: A Case Series

Islam, Lucrezia; Franzini, Angelo; Messina, Giuseppe; Scarone, Silvio; Gambini, Orsola

doi:10.1016/j.wneu.2014.12.024

Cited by 58 publications

(43 citation statements)

References 41 publications

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“…53,111 Stimulation of the stria terminalis for OCD has not been extensively studied, but in a limited case series it was found to be comparably efficacious to NAcc stimulation. 113 The specific target remains unclear, though, with another group targeting the junction between the NAcc and the caudate nucleus. These authors argue that the improvement in compulsive symptoms is actually secondary to caudate stimulation, whereas NAcc stimulation primarily mitigates the depressive symptoms.…”

Section: 53mentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

Cleary

Ozpinar

Raslan

et al. 2015

FOC

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Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned. Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry. This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.

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Section: 53mentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

Cleary

Ozpinar

Raslan

et al. 2015

FOC

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“…The advent of DBS as a therapy for advanced movement disorders has generated interest in novel indications such as OCD 11. While several DBS targets are under study and have exhibited promise, including the anterior limb of the internal capsule,12 the nucleus accumbens,10 13 14 subthalamic nucleus13 15 and the bed nucleus of the stria terminalis,16 there have been no reported, demonstrable differences between targets 17. Importantly, several established DBS targets are in close proximity anatomically and thus stimulation to one area has potential off-target effects 18–20.…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of neuroablation and deep brain stimulation for treatment-resistant obsessive-compulsive disorder: a meta-analytic study

Kumar

Appelboom

Lamsam

et al. 2019

J Neurol Neurosurg Psychiatry

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BackgroundThe safety and efficacy of neuroablation (ABL) and deep brain stimulation (DBS) for treatment refractory obsessive-compulsive disorder (OCD) has not been examined. This study sought to generate a definitive comparative effectiveness model of these therapies.MethodsA EMBASE/PubMed search of English-language, peer-reviewed articles reporting ABL and DBS for OCD was performed in January 2018. Change in quality of life (QOL) was quantified based on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the impact of complications on QOL was assessed. Mean response of Y-BOCS was determined using random-effects, inverse-variance weighted meta-analysis of observational data.FindingsAcross 56 studies, totalling 681 cases (367 ABL; 314 DBS), ABL exhibited greater overall utility than DBS. Pooled ability to reduce Y-BOCS scores was 50.4% (±22.7%) for ABL and was 40.9% (±13.7%) for DBS. Meta-regression revealed no significant change in per cent improvement in Y-BOCS scores over the length of follow-up for either ABL or DBS. Adverse events occurred in 43.6% (±4.2%) of ABL cases and 64.6% (±4.1%) of DBS cases (p<0.001). Complications reduced ABL utility by 72.6% (±4.0%) and DBS utility by 71.7% (±4.3%). ABL utility (0.189±0.03) was superior to DBS (0.167±0.04) (p<0.001).InterpretationOverall, ABL utility was greater than DBS, with ABL showing a greater per cent improvement in Y-BOCS than DBS. These findings help guide success thresholds in future clinical trials for treatment refractory OCD.

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“…In our post hoc analysis, we did not find relevant demographic or clinical predictors. Often discussed aspects that may reduce the effectiveness of DBS for OCD, such as poor insight into the irrationality of obsessions and compulsions,27 personality traits and symptom categories as measured by the HZI, did not significantly correlate with the outcome. Thus, further research on which patient qualifies best for neuromodulation is highly important to improving this treatment strategy.…”

Section: Discussionmentioning

confidence: 99%

Open-label trial of anterior limb of internal capsule–nucleus accumbens deep brain stimulation for obsessive-compulsive disorder: insights gained

Huys

Kohl

Baldermann

et al. 2019

J Neurol Neurosurg Psychiatry

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BackgroundFor more than 15 years, deep brain stimulation (DBS) has served as a last-resort treatment for severe treatment-resistant obsessive-compulsive disorder (OCD).MethodsFrom 2010 to 2016, 20 patients with OCD (10 men/10 women) were included in a single-centre trial with a naturalistic open-label design over 1 year to evaluate the effects of DBS in the anterior limb of the internal capsule and nucleus accumbens region (ALIC-NAcc) on OCD symptoms, executive functions, and personality traits.ResultsALIC-NAcc-DBS significantly decreased OCD symptoms (mean Yale-Brown Obsessive Compulsive Scale reduction 33%, 40% full responders) and improves global functioning without loss of efficacy over 1 year. No significant changes were found in depressive or anxiety symptoms. Our study did not show any effect of ALIC-NAcc-DBS on personality traits or executive functions, and no potential outcome predictors were identified in a post hoc analysis. Other than several individual minor adverse events, ALIC-NAcc-DBS has been shown to be safe, but 35% of patients reported a sudden increase in anxiety and anhedonia after acute cessation of stimulation.ConclusionsWe conclude that ALIC-NAcc-DBS is a well-tolerated and promising last-resort treatment option for OCD. The cause of variability in the outcome remains unclear, and the aspect of reversibility must be examined critically. The present data from one of the largest samples of patients with OCD treated with DBS thus far support the results of previous studies with smaller samples.

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Deep Brain Stimulation of the Nucleus Accumbens and Bed Nucleus of Stria Terminalis for Obsessive-Compulsive Disorder: A Case Series

Cited by 58 publications

References 41 publications

Deep brain stimulation for psychiatric disorders: where we are now

Deep brain stimulation for psychiatric disorders: where we are now

Comparative effectiveness of neuroablation and deep brain stimulation for treatment-resistant obsessive-compulsive disorder: a meta-analytic study

Open-label trial of anterior limb of internal capsule–nucleus accumbens deep brain stimulation for obsessive-compulsive disorder: insights gained

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