Efficacy of Deep Brain Stimulation of the Ventral Anterior Limb of the Internal Capsule for Refractory Obsessive-Compulsive Disorder: A Clinical Cohort of 70 Patients

Abstract

Deep brain stimulation (DBS) is an effective treatment option for patients with refractory obsessivecompulsive disorder (OCD). However, clinical experience with DBS for OCD remains limited. The authors examined the tolerability and effectiveness of DBS in an open study of patients with refractory OCD.Methods: Seventy consecutive patients, including 16 patients from a previous trial, received bilateral DBS of the ventral anterior limb of the internal capsule (vALIC) between April 2005 and October 2017 and were followed for 12 months. Primary effectiveness was assessed by the change in scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) from baseline until the 12-month follow-up. Response was defined by a $35% decrease in Y-BOCS score, partial response was defined by a 25%234% decrease, and nonresponse was defined by a ,25% decrease. Secondary effectiveness measures were the Hamilton Anxiety Rating Scale (HAM-A) and the Hamilton Depression Rating Scale (HAM-D).Results: Y-BOCS, HAM-A, and HAM-D scores all decreased significantly during the first 12 months of DBS. Twelve months of DBS resulted in a mean Y-BOCS score decrease of 13.5 points (SD=9.4) (40% reduction; effect size=1.5). HAM-A scores decreased by 13.4 points (SD=9.7) (55%; effect size= 1.4), and HAM-D scores decreased by 11.2 points (SD= 8.8) (54%; effect size=1.3). At the 12-month follow-up, 36 of the 70 patients were categorized as responders (52%), 12 patients as partial responders (17%), and 22 patients as nonresponders (31%). Adverse events included transient symptoms of hypomania, agitation, impulsivity, and sleeping disorders.Conclusions: These results confirm the effectiveness and safety of DBS of the vALIC for patients with treatmentrefractory OCD in a regular clinical setting.

Long-term Outcome of Deep Brain Stimulation of the Ventral Part of the Anterior Limb of the Internal Capsule in a Cohort of 50 Patients With Treatment-Refractory Obsessive-Compulsive Disorder

“…Two weeks after implantation, patients entered an optimization phase, optimizing symptom suppression while controlling side effects (15). As soon as DBS resulted in adequate Y-BOCS decrease, trained CBT therapists provided a CBT program of #24 sessions.…”

“…After CBT, patients were seen at least annually for follow-up at our outpatient clinic. Denys et al (15) provide more detailed information about the treatment protocol.…”

Case Report of Dual-Site Neurostimulation and Chronic Recording of Cortico-Striatal Circuitry in a Patient With Treatment Refractory Obsessive Compulsive Disorder

“…Nevertheless, the patient's feelings of improvement may be important, given that they represent a change from previous treatments, and that the PGI-I has been shown to be related to more objective measures of symptom improvement in larger samples (e.g., Yalcin and Bump, 2003). Overall satisfaction with DBS therapy, despite a lack of response to the treatment has been described before (e.g., Denys et al, 2020). It is possible that this effect represents changes in overall mood, or the limitations of the YBOCS in terms of sensitivity to change at extremes of pathology (van Westen et al, 2020).…”

The Use of Tractography-Based Targeting in Deep Brain Stimulation for Psychiatric Indications

“…The ventral striatum/ventral capsule (VC/VS), used here to refer to the highly similar ventral anterior limb of the internal capsule (vALIC) and the nucleus accumbens (NAc) targets, is the most common DBS target in the treatment of OCD (Hamani et al, 2014b;Denys et al, 2020), but also frequently used in the treatment of MDD (Dougherty et al, 2015). Although openlabel trials of VC/VS DBS have yielded long-term response rates ranging from 40 to 66% for OCD and MDD (Greenberg et al, 2010;Bewernick et al, 2012;van der Wal et al, 2019;Winter et al, 2020), an industry-sponsored RCT of VC/VS DBS for MDD failed to show a difference between true and placebo stimulation for MDD (Dougherty et al, 2015).…”