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

Abstract

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.

Deep Brain Stimulation: Imaging on a group level

“…Examples that utilized group statistics span across different diseases like PD (Bouthour et al, 2019;Horn et al, 2019c), essential tremor (Al-Fatly et al, 2019;Kroneberg et al, 2019), Dystonia (Neumann et al, 2017), Meige syndrome (Yao et al, 2019), OCD Huys et al, 2019), epilepsy (Middlebrooks et al, 2018;Wang et al, 2019), Tourette's Syndrome (W. J. or refractory thalamic pain syndrome (Levi et al, 2019). Using Lead-DBS, a sweet spot for STN-DBS in PD was defined and used to predict improvement of motor symptoms in out-of-sample data (Dembek et al, 2019a).…”

Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder: Towards an Individualized Approach

“…Case reports and open studies have reported that about 50% of OCD patients respond favorably to ALIC-DBS (64 -68). A recent open-label study, including the largest cohort of 20 refractory OCD patients stimulated in the ALIC, reported 40% of responders 1 year after surgery (68). Adverse events were limited to one case due to hardware infection, and transient effects due to DBS settings, such as hypomania, disinhibition, lack of concentration, transient loss of energy, sleep disturbances, and >20% weight gain (68).…”

“…A recent open-label study, including the largest cohort of 20 refractory OCD patients stimulated in the ALIC, reported 40% of responders 1 year after surgery (68). Adverse events were limited to one case due to hardware infection, and transient effects due to DBS settings, such as hypomania, disinhibition, lack of concentration, transient loss of energy, sleep disturbances, and >20% weight gain (68). If the clinical effects of ALIC-DBS on refractory OCD were encouraging, a confirmation level I study is still needed (69).…”

“…Recently, individual clinical features of OCD were not found to be predictors of response to DBS in a large cohort (n = 20) (68). Neuroimaging techniques such as resting-state functional connectivity or DWI have shed a new light on the relationship between anatomical locations of the DBS target and response to stimulation.…”

Prefrontal delta oscillations during deep brain stimulation predict treatment success in patients with obsessive-compulsive disorder

“…This study included data from ten patients (5 females) with refractory and severe (Yale-Brown Obsessive Compulsive Scale [YBOCS] 25) OCD that were being treated with DBS implants in the VC/VS (for details on study design and recruitment see Ref. [7]). Patients underwent bilateral stereotactic implantation of quadripolar leads (Model 3387 or 3389 DBS Lead; Medtronic; Minneapolis, MN, USA) with the two most ventral/distal contacts targeting the VS and two most dorsal/proximal contacts located in the VC (Fig.…”