Changes of oscillatory activity in the subthalamic nucleus during obsessive-compulsive disorder symptoms: Two case reports

IntroductionSeveral studies along the last two decades provide information indicating the relationship between posttraumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD). The particular features described in patients who developed OCD symptoms closely after the onset of PTSD, may suggest the existence of a specific subtype of OCD more likely to be suffered after a traumatic event. The few studies focused on evaluating treatment efficacy for the association between OCD and PTSD seem to predict poor response to pharmacologic or behavioral cognitive (BCT) monotherapy.ObjectivesDespite the evidence, most widely used guidelines propose the employment of either a psychotherapeutic or psychopharmacologic approach. We propose to combine intensive BCT and serotonin profile antidepressants in order to optimize PTSD-OCD subtype.Material and methodsWe present two detailed case reports offering the results of combining intensive BCT and serotonin profile antidepressants as soon as the comorbid diagnosis for both disorders was established. These two patients were recruited from outpatient care centers.ResultsOur limited experience supplied promising outcome results. Significant improvement regarding to functional impairment appeared from early stages of the treatment in both patients.DiscussionDespite logistic difficulties, an intensive and coordinated psychopharmacologic and psychotherapeutic approach might constitute another treatment choice which may be taken into account in those cases monotherapy fails to reduce PTSD-OCD subtype patients’ impairment.ConclusionsA mixed treatment approach might be taken into account as a first line treatment in PTSD-OCD disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Effect of subthalamic nucleus stimulation on obsessive—compulsive disorder in a patient with Parkinson disease

Journal of Neurosurgery ◽

10.3171/jns.2004.100.6.1084 ◽

2004 ◽

Vol 100 (6) ◽

pp. 1084-1086 ◽

Cited By ~ 113

Author(s):

Denys Fontaine ◽

Vianney Mattei ◽

Michel Borg ◽

Daniel von Langsdorff ◽

Marie-Noelle Magnie ◽

...

Keyword(s):

Parkinson Disease ◽

Obsessive Compulsive Disorder ◽

Subthalamic Nucleus ◽

Obsessive Compulsive ◽

Content Type ◽

Motor Disability ◽

Compulsive Disorder ◽

Subthalamic Nucleus Stimulation ◽

Scale Scores ◽

Fine Print

✓ The authors report on a patient with Parkinson disease (PD) and severe obsessive—compulsive disorder (OCD), in whom bilateral stimulation of the subthalamic nucleus (STN) was used to treat both PD and OCD symptoms. This 49-year-old man had displayed symptoms of PD for 13 years. Progressively, his motor disability became severe despite optimal medical treatment. In parallel, he suffered severe OCD for 16 years, with obsessions of accumulation and compulsions of gathering and rubbing that lasted more than 8 hours per day. Bilateral high-frequency STN stimulation was performed to treat motor disability. After surgery (at 1-year follow up), motor and OCD symptoms were dramatically improved. The pre- and postoperative Yale—Brown Obsessive—Compulsive Scale scores were 32 and 1, respectively. No additional antiparkinsonian drugs were administered. This case and other recent reports indicate that OCD symptoms can be improved by deep brain stimulation, a finding that opens new perspectives in the surgical treatment of severe and medically intractable OCD.

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