Department of Psychiatry, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida, USA.
Brain Stimul. 2012 Oct;5(4):599-604. doi: 10.1016/j.brs.2011.10.004. Epub 2011 Nov 4.
Deep brain stimulation (DBS) is a promising treatment for medication refractory obsessive compulsive disorder (OCD); however, there may be neuropsychiatric symptoms from unintended battery failure.
Previous studies indicated rebound symptoms from impulse generator (IPG) failure in Parkinson's disease, dystonia, and essential tremor. Unique to OCD is that battery failure may precipitate neuropsychiatric symptoms rather than motor symptoms.
Six patients with medication refractory OCD received implants as part of the previously reported National Institutional Health (NIH) DBS cohort. All available clinical data and adverse event data was reviewed.
The average age of cohort was 42.2 years (30-59 years), and the average baseline Y-BOCS score was 33.8 (31-38). All six subjects were observed to have increased OCD symptomatology during IPG failure; however, Y-BOCS scores remained less than pretreatment range, in five subjects. One of the subjects had a Y-BOCS score greater than pretreatment during the period of IPG failure. In addition, Y-BOCS scores improved back to baseline after IPG replacement in five subjects. Other symptoms potentially related to battery failure included: suicidality (n = 1), mood disturbance (n = 2), panic attacks (n = 1), fatigue (n = 2), and a restless sensation in the arms and legs (n = 1). A small number of subjects reported no side effects associated with IPG failure because of preemptive replacement (n = 2).
This is a preliminary case series detailing the side effects resulting from IPG failure during OCD DBS. Preemptive battery replacement was an effective strategy for avoiding these issues, and timeliness in insurance reimbursement may be considered in the future. Additionally the use of rechargeable batteries may also help this issue.
NCT00057603.
深部脑刺激（DBS）是治疗药物难治性强迫症（OCD）的一种有前途的方法；然而，由于电池意外故障，可能会出现神经精神症状。
先前的研究表明，在帕金森病、肌张力障碍和原发性震颤中，脉冲发生器（IPG）故障会导致反弹症状。OCD 的独特之处在于电池故障可能引发神经精神症状，而不是运动症状。
6 名药物难治性 OCD 患者作为先前报道的国家机构健康（NIH）DBS 队列的一部分接受了植入。回顾了所有可用的临床数据和不良事件数据。
队列的平均年龄为 42.2 岁（30-59 岁），平均基线 Y-BOCS 评分为 33.8（31-38）。在 IPG 故障期间，所有 6 名患者均观察到 OCD 症状加重；然而，在 5 名患者中，Y-BOCS 评分仍低于治疗前范围。其中 1 名患者在 IPG 故障期间的 Y-BOCS 评分高于治疗前。此外，在 5 名患者中，IPG 更换后 Y-BOCS 评分恢复到基线。与电池故障相关的其他症状包括：自杀意念（n = 1）、情绪障碍（n = 2）、惊恐发作（n = 1）、疲劳（n = 2）和手臂和腿部不安感（n = 1）。少数患者因提前更换而报告与 IPG 故障无关的副作用（n = 2）。
这是一项详细描述 OCD DBS 中 IPG 故障导致的副作用的初步病例系列研究。预防性电池更换是避免这些问题的有效策略，未来可能需要考虑保险报销的及时性。此外，使用可充电电池也可能有助于解决这个问题。
NCT00057603。
