Invasive and Non-invasive Neurostimulation for OCD

Bergfeld, Isidoor O.; Dijkstra, Eva; Graat, Ilse; Koning, Pelle de; Boom, Bastijn J.G. van den; Arbab, Tara; Vulink, Nienke; Denys, Damiaan; Willuhn, Ingo; Mocking, Roel J. T.

doi:10.1007/7854_2020_206

Cited by 38 publications

(30 citation statements)

References 150 publications

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“…The number of SAE's reflects the challenging nature of this study. Transient hypomanic and impulsive symptoms may be caused by downregulation of reward and emotion regulation circuitries due to DBS [4,10]. We hypothesize that vALIC-DBS inhibits positive reinforcement of ritualistic AN behavior making them useless as a coping strategy.…”

Section: Dear Editormentioning

confidence: 95%

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Deep brain stimulation of the ventral anterior limb of the capsula interna in patients with treatment-refractory anorexia nervosa

et al. 2021

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Section: Dear Editormentioning

confidence: 95%

“…We included a sample of patients with exceptionally severe AN. Although challenging, they reflect the prototypical patients that may be eligible for DBS as a last resort treatment option [4].…”

Section: Dear Editormentioning

confidence: 99%

Deep brain stimulation of the ventral anterior limb of the capsula interna in patients with treatment-refractory anorexia nervosa

et al. 2021

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“…How can we understand the thousand-fold difference in application, although technology and treatment results are similar? In PD, the effect sizes for the reduction of motor symptoms and functional improvement are large (SMD > 0.80) ( 2 ), while in OCD, the effect size for reduction of OCD-symptoms is comparable (hedges' g = 2.5, 95%CI = 1.9–3.0) ( 3 ). Of the patients with OCD that showed insufficient response to pharmacotherapy or psychotherapy, more than half show complete response to DBS in randomized placebo-controlled trials (RCTs) (I 2 = 0%; p = 0.003), with a number needed to treat of 3 ( 4 ).…”

Section: Psychiatry Vs Neurologymentioning

confidence: 99%

“…However, a recent meta-analysis showed that DBS is equally effective as ablative surgery in treatment refractory OCD ( 10 ). Others may prefer non-invasive neurostimulation techniques like transcranial magnetic stimulation (TMS) than DBS, but contrary to the latter, more than half of TMS studies found no significant benefit over sham stimulation in OCD ( 3 ). One may hypothesize that patients are more difficult to recruit, that companies are less interested, that funding agencies are less convinced, or that psychiatrists lacked sufficient expertise.…”

Section: Stagnation Of Dbs In Psychiatrymentioning

confidence: 99%

Why Has Deep Brain Stimulation Had So Little Impact in Psychiatry?

2021

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Over two decades ago, the first scientific publication on deep brain stimulation (DBS) in psychiatry was published. The evidence for effectiveness of DBS for several psychiatric disorders has been steadily accumulating since the first report of DBS for Obsessive Compulsive Disorder (OCD) in 1999. However, the number of psychiatric patients treated with DBS is lagging behind, particularly in comparison with neurology. The number of patients treated with DBS for psychiatric indications worldwide probably does not exceed 500, compared to almost 300,000 patients with neurological disorders that have been treated with DBS within the same period of 20 years. It is not the lack of patients, knowledge, technology, or efficacy of DBS that hinders its development and application in psychiatry. Here, we discuss the reasons for the gap between DBS in neurology and in psychiatry, which seemed to involve the scientific and social signature of psychiatry.

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“…Originally developed by Heath for use in psychiatric disorders ( O’Neal et al, 2017 ) and later pain ( Hosobuchi et al, 1977 ; Richardson and Akil, 1977 ), its main use currently is for movement disorders ( Krack et al, 2019 ). More recently, its use in psychiatric disorders has enjoyed a renaissance ( Cleary et al, 2015 ; Graat et al, 2017 ): obsessive–compulsive disorder (OCD) ( de Haan et al, 2017 ; Bergfeld et al, 2021 ) and it has been used in depression ( Malone et al, 2009 ; Bewernick et al, 2010 ) and addiction ( Wang et al, 2018 ; Vannemreddy and Slavin, 2019 ). Most studies targeted the ventral striatum (VS)/nucleus accumbens (NAcc) ( Malone et al, 2009 ; Bewernick et al, 2010 ) and subcallosal cingulate ( Lozano et al, 2008 , 2012 ; Lipsman et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation of the Nucleus Accumbens in Severe Enduring Anorexia Nervosa: A Pilot Study

Scaife

Eraifej

Green

et al. 2022

Front. Behav. Neurosci.

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IntroductionAnorexia nervosa (AN) is one of the most debilitating psychiatric disorders, becoming severe and enduring in a third of cases; with few effective treatments. Deep brain stimulation is a reversible, adjustable neurosurgical procedure that has been gaining ground in psychiatry as a treatment for depression and obsessive–compulsive disorder, yet few studies have investigated AN. Abnormal eating behavior and the compulsive pursuit of thinness in AN is, in part, a consequence of dysfunction in reward circuitry and the nucleus accumbens (NAcc) is central to reward processing.MethodsPhase 1 prospective open-label pilot study of seven individuals with severe enduring AN. Electrodes were implanted bilaterally into the NAcc with stimulation at the anterior limb of the internal capsule using rechargeable implantable pulse generators. The protocol of 15 months included 12 months of deep brain stimulation incorporating two consecutive, randomized blind on-off fortnights 9 months after stimulation onset. The primary objectives were to investigate safety and feasibility, together with changes in eating disorder psychopathology.ResultsFeasibility and safety was demonstrated with no serious adverse events due to deep brain stimulation. Three patients responded to treatment [defined as > 35% reduction in Eating Disorders Examination (EDE) score at 12 months] and four patients were non-responders. Responders had a statistically significant mean reduction in EDE scores (50.3% reduction; 95% CI 2.6–98.2%), Clinical Impairment Assessment (45.6% reduction; 95% CI 7.4–83.7%). Responders also had a statistically significant mean reduction in Hamilton Depression Scale, Hamilton Anxiety Scale and Snaith-Hamilton pleasure scale. There were no statistically significant changes in Body Mass Index, Yale-Brown-Cornell Eating Disorder Scale, Yale-Brown Obsessive–Compulsive Scale and World Health Organization Quality of Life Psychological subscale.ConclusionThis study provides some preliminary indication that deep brain stimulation to the NAcc. Might potentially improve some key features of enduring AN. In this small study, the three responders had comorbid obsessive-compulsive disorder which predated AN diagnosis. Future studies should aim to further elucidate predictors of outcome.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [Project ID 128658].

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Invasive and Non-invasive Neurostimulation for OCD

Cited by 38 publications

References 150 publications

Deep brain stimulation of the ventral anterior limb of the capsula interna in patients with treatment-refractory anorexia nervosa

Deep brain stimulation of the ventral anterior limb of the capsula interna in patients with treatment-refractory anorexia nervosa

Why Has Deep Brain Stimulation Had So Little Impact in Psychiatry?

Deep Brain Stimulation of the Nucleus Accumbens in Severe Enduring Anorexia Nervosa: A Pilot Study

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