Mulders Anne E P, Leentjens Albert F G, Schruers Koen, Duits Annelien, Ackermans Linda, Temel Yasin
Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands.
Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, the Netherlands.
World Neurosurg. 2017 Aug;104:1048.e9-1048.e13. doi: 10.1016/j.wneu.2017.05.067. Epub 2017 May 19.
Patients with treatment-resistant obsessive-compulsive disorder (OCD) are potential candidates for deep brain stimulation (DBS). The anteromedial subthalamic nucleus (STN) is among the most commonly used targets for DBS in OCD.
We present a patient with a 30-year history of treatment-resistant OCD who underwent anteromedial STN-DBS. Despite a clear mood-enhancing effect, stimulation caused motor side effects, including bilateral hyperkinesia, dyskinesias, and sudden large amplitude choreatic movements of arms and legs when stimulating at voltages greater than approximately 1.5 V. DBS at lower amplitudes and at other contact points failed to result in a significant reduction of obsessions and compulsions without inducing motor side effects. Because of this limitation in programming options, we decided to reoperate and target the ventral capsule/ventral striatum (VC/VS), which resulted in a substantial reduction in key obsessive and compulsive symptoms without serious side effects.
Choreatic movements and hemiballismus have previously been linked to STN dysfunction and have been incidentally reported as side effects of DBS of the dorsolateral STN in Parkinson disease (PD). However, in PD, these side effects were usually transient, and they rarely interfered with DBS programming. In our patient, the motor side effects were persistent, and they made optimal DBS programming impossible. To our knowledge, such severe and persistent motor side effects have not been described previously for anteromedial STN-DBS.
难治性强迫症（OCD）患者是深部脑刺激（DBS）的潜在候选对象。丘脑底核前内侧部（STN）是OCD患者DBS最常用的靶点之一。
我们报告一名有30年难治性OCD病史的患者接受了STN前内侧部DBS治疗。尽管刺激有明显的情绪改善作用，但在电压大于约1.5V时，刺激引起了运动副作用，包括双侧运动增多、异动症以及手臂和腿部突然出现的大幅度舞蹈样动作。较低幅度刺激及在其他触点进行DBS未能显著减轻强迫观念和强迫行为，且未引发运动副作用。由于编程选择存在这种局限性，我们决定再次手术，将腹侧囊/腹侧纹状体（VC/VS）作为靶点，这使得主要的强迫观念和强迫行为症状大幅减轻，且无严重副作用。
舞蹈样动作和偏身投掷症此前与STN功能障碍有关，在帕金森病（PD）中，这些症状曾作为背外侧STN-DBS的副作用被偶然报道。然而，在PD中，这些副作用通常是短暂的，很少干扰DBS编程。在我们的患者中，运动副作用持续存在，使得无法进行最佳的DBS编程。据我们所知，此前尚未描述过STN前内侧部DBS出现如此严重且持续的运动副作用。
