scholarly journals The medial forebrain bundle as a target for deep brain stimulation for obsessive-compulsive disorder

CNS Spectrums ◽  
2016 ◽  
Vol 22 (3) ◽  
pp. 282-289 ◽  
Author(s):  
Volker A. Coenen ◽  
Thomas E. Schlaepfer ◽  
Peter Goll ◽  
Peter C. Reinacher ◽  
Ulrich Voderholzer ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Major Depression ◽  
Brain Stimulation ◽  
Medial Forebrain Bundle ◽  
Reward System ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Deep Brain

Deep brain stimulation (DBS) is a promising putative modality for the treatment of refractory psychiatric disorders such as major depression and obsessive-compulsive disorder (OCD). Several targets have been posited; however, a clear consensus on differential efficacy and possible modes of action remain unclear. DBS to the supero-lateral branch of the medial forebrain bundle (slMFB) has recently been introduced for major depression (MD). Due to our experience with slMFB stimulation for MD, and because OCD might be related to similar dysfunctions of the reward system, treatment with slMFB DBS seams meaningful. Here we describe our first 2 cases together with a hypothetical mode of action.We describe diffusion tensor imaging (DTI) fiber tractographically (FT)-assisted implantation of the bilateral DBS systems in 2 male patients. In a selected literature overview, we discuss the possible mode of action. Both patients were successfully implanted and stimulated. The follow-up time was 12 months. One patient showed a significant response (Yale–Brown Obsessive-Compulsive Scale [YBOCS] reduction by 35%); the other patient reached remission criteria 3 months after surgery (YBOCS<14) and showed mild OCD just above the remission criterion at 12 months follow-up.While the hypermetabolism theory for OCD involves the cortico–striato–thalamo–cortical (CSTC) network, we think that there is clinical evidence that the reward system plays a crucial role. Our findings suggest an important role of this network in mechanisms of disease development and recovery. In this uncontrolled case series, continuous bilateral DBS to the slMFB led to clinically significant improvements of ratings of OCD severity. Ongoing research focuses on the role of the reward system in OCD, and its yet-underestimated role in this underlying neurobiology of the disease.

scholarly journals Deep brain stimulation of the subthalamic nucleus in obsessive–compulsives disorders: long-term follow-up of an open, prospective, observational cohort

2020 ◽  
Vol 91 (12) ◽  
pp. 1349-1356
Author(s):  
Stephan Chabardes ◽  
Paul Krack ◽  
Brigitte Piallat ◽  
Thierry Bougerol ◽  
Eric Seigneuret ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Safe Procedure ◽  
Obsessive Compulsive ◽  
Open Label ◽  
Compulsive Disorder ◽  
The Impact ◽  
Deep Brain

BackgroundObsessive–compulsive disorder (OCD) is a major cause of disability in western country and responsible for severe impairment of quality of life. About 10% of patients present with severe OCD symptoms and require innovative treatment such as deep brain stimulation (DBS). Among possible targets, the non-motor subthalamic nucleus (STN) is a key node of the basal ganglia circuitry, strongly connected to limbic cortical areas known to be involved in OCD.MethodWe analysed, in a prospective, observational, monocentric, open label cohort, the effect of chronic non-motor STN-DBS in 19 patients with treatment-resistant OCD consecutively operated in a single centre. Severity of OCD was evaluated using the Yale and Brown Obsessive–Compulsive Scale (YBOCS). YBOCS scores at 6, 12 and 24 months postoperatively were compared with baseline. Responders were defined by >35% improvement of YBOCS scores. Global Assessment Functioning (GAF) scale was used to evaluate the impact of improvement.ResultsAt a 24-month follow-up, the mean YBOCS score improved by 53.4% from 33.3±3.5 to 15.8±9.1 (95% CI 11.2–20.4; p<0.0001). Fourteen out of 19 patients were considered as responders, 5 out of 19 being improved over 75% and 10 out of 19 over 50%. GAF scale improved by 92% from 34.1±3.9 to 66.4±18.8 (95% CI 56.7–76.1; p=0.0003). The most frequent adverse events consisted of transient DBS-induced hypomania and anxiety.ConclusionChronic DBS of the non-motor STN is an effective and relatively safe procedure to treat severe OCD resistant to conventional management.

Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive—compulsive disorder and major depression

2004 ◽  
Vol 101 (4) ◽  
pp. 682-686 ◽  
Author(s):  
Bruno Aouizerate ◽  
Emmanuel Cuny ◽  
Corinne Martin-Guehl ◽  
Dominique Guehl ◽  
Helene Amieva ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Major Depression ◽  
Caudate Nucleus ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Depression And Anxiety ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Deep Brain ◽  
Stimulation Of

✓ Obsessive—compulsive disorder (OCD) is an anxiety disorder associated with recurrent intrusive thoughts and repetitive behaviors. Although conventional pharmacological and/or psychological treatments are well established and effective in treating OCD, symptoms remain unchanged in up to 30% of patients. Deep brain stimulation (DBS) of the anterior limb of the internal capsule has recently been proposed as a possible therapeutic alternative in treatment-resistant OCD. In the present study, the authors tested the hypothesis that DBS of the ventral caudate nucleus might be effective in a patient with intractable severe OCD and concomitant major depression. Psychiatric assessment included the Yale—Brown Obsessive Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), and the Global Assessment of Functioning (GAF) Scale for determining the symptom severity of OCD, depression, and anxiety as well as the quality of pychosocial and occupational functioning, respectively. Neuropsychological assessment consisted of a wide range of tests primarily exploring memory and executive functions. Deep brain stimulation of the ventral caudate nucleus markedly improved symptoms of depression and anxiety until their remission, which was achieved at 6 months after the start of stimulation (HDRS ≤ 7 and HARS ≤ 10). Remission of OCD (Y-BOCS < 16) was also delayed after 12 or 15 months of DBS. The level of functioning pursuant to the GAF scale progressively increased during the 15-month follow-up period. No neuropsychological deterioration was observed, indicating that DBS of the ventral caudate nucleus could be a promising strategy in the treatment of refractory cases of both OCD and major depression.

Deep Brain Stimulation for Obsessive-Compulsive Disorder Affects Language

Neurosurgery ◽  
2013 ◽  
Vol 73 (5) ◽  
pp. E907-E910 ◽  
Author(s):  
A. Rosaura Polak ◽  
Anke B. Witteveen ◽  
Mariska Mantione ◽  
Martijn Figee ◽  
Pelle de Koning ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Nucleus Accumbens ◽  
Obsessive Compulsive Disorder ◽  
Brain Stimulation ◽  
Clinical Presentation ◽  
Symptom Improvement ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Deep Brain

Abstract BACKGROUND AND IMPORTANCE: Deep brain stimulation (DBS) is an effective treatment for patients with refractory neuropsychiatric disorders. Along with symptom improvement, DBS may have concurrent behavioral effects that help to unravel the role of specific brain circuitries in complex human behavior. CLINICAL PRESENTATION: This article reports on 2 patients with obsessive-compulsive disorder who received DBS targeted at the nucleus accumbens that resulted in a temporary change of accent and use of vocabulary. CONCLUSION: Changes in accent and speaking manners are most likely related to direct DBS stimulation effects of the electrode targeted at the nucleus accumbens. The shift in accent, resembling foreign accent syndrome after injuries in brain language centers, has not been reported before in the course of DBS. Induction of aggressive vocabulary may be related to transient hypomanic behavior after DBS.

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