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Deep brain stimulation for treatment resistant obsessive compulsive disorder; an observational study with ten patients under real-life conditions.

作者信息

Abdelnaim Mohamed A, Lang-Hambauer Verena, Hebel Tobias, Schoisswohl Stefan, Schecklmann Martin, Deuter Daniel, Schlaier Juergen, Langguth Berthold

机构信息

Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany.

Center for Deep Brain Stimulation, University Regensburg, Regensburg, Germany.

出版信息

Front Psychiatry. 2023 Sep 13;14:1242566. doi: 10.3389/fpsyt.2023.1242566. eCollection 2023.


DOI:10.3389/fpsyt.2023.1242566
PMID:37779611
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10533930/
Abstract

INTRODUCTION: Obsessive-compulsive disorder (OCD) affects 2-3% of the global population, causing distress in many functioning levels. Standard treatments only lead to a partial recovery, and about 10% of the patients remain treatment-resistant. Deep brain stimulation offers a treatment option for severe, therapy-refractory OCD, with a reported response of about 60%. We report a comprehensive clinical, demographic, and treatment data for patients who were treated with DBS in our institution. METHODS: We offered DBS to patients with severe chronic treatment resistant OCD. Severity was defined as marked impairment in functioning and treatment resistance was defined as non-response to adequate trials of medications and psychotherapy. Between 2020 and 2022, 11 patients were implanted bilaterally in the bed nucleus of stria terminalis (BNST). Patients were evaluated with YBOCS, MADRS, GAF, CGI, and WHOQOL-BREF. We performed the ratings at baseline (before surgery), after implantation before the start of the stimulation, after reaching satisfactory stimulation parameters, and at follow-up visits 3, 6, 9, and 12 months after optimized stimulation. RESULTS: One patient has retracted his consent to publish the results of his treatment, thus we are reporting the results of 10 patients (5 males, 5 females, mean age: 37 years). Out of our 10 patients, 6 have shown a clear response indicated by a YBOCS-reduction between 42 and 100 percent at last follow-up. One further patient experienced a subjectively dramatic effect on OCD symptoms, but opted afterwards to stop the stimulation. The other 3 patients showed a slight, non-significant improvement of YBOCS between 8.8 and 21.9%. The overall mean YBOCS decreased from 28.3 at baseline to 13.3 (53% reduction) at the last follow-up. The improvement of the OCD symptoms was also accompanied by an improvement of depressive symptoms, global functioning, and quality of life. CONCLUSION: Our results suggest that BNST-DBS can be effective for treatment-resistant OCD patients, as indicated by a reduction in symptoms and an overall improvement in functioning. Despite the need for additional research to define the patients' selection criteria, the most appropriate anatomical target, and the most effective stimulation parameters, improved patient access for this therapy should be established.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5665/10533930/6d8e9f8b5719/fpsyt-14-1242566-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5665/10533930/a2b90afa4825/fpsyt-14-1242566-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5665/10533930/b6444edc5a46/fpsyt-14-1242566-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5665/10533930/435fe8944d58/fpsyt-14-1242566-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5665/10533930/ac2dfd1d3934/fpsyt-14-1242566-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5665/10533930/6d8e9f8b5719/fpsyt-14-1242566-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5665/10533930/a2b90afa4825/fpsyt-14-1242566-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5665/10533930/b6444edc5a46/fpsyt-14-1242566-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5665/10533930/435fe8944d58/fpsyt-14-1242566-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5665/10533930/ac2dfd1d3934/fpsyt-14-1242566-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5665/10533930/6d8e9f8b5719/fpsyt-14-1242566-g005.jpg

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引用本文的文献

[1]
Deep brain stimulation for obsessive compulsive disorder leads to symptom changes of comorbid irritable bowel syndrome.

Front Psychiatry. 2025-3-5

[2]
Neuronavigated Right Orbitofrontal 20 Hz Theta Burst Transcranial Magnetic Stimulation Augmentation for Obsessive-Compulsive Disorder with Comorbid Depression and Anxiety Disorders: An Open-Label Study.

Brain Sci. 2024-5-10

[3]
Ketamine Infusion in a Resistant Obsessive-Compulsive Disorder Patient in Bangladesh with Severe Suicidal Ideation: A Case Report.

Cureus. 2024-4-8

本文引用的文献

[1]
Deep brain stimulation in obsessive-compulsive disorder: Results from meta-analysis.

Psychiatry Res. 2022-11

[2]
Efficacy of deep brain stimulation for treatment-resistant obsessive-compulsive disorder: systematic review and meta-analysis.

J Neurol Neurosurg Psychiatry. 2022-9-20

[3]
Deep brain stimulation for obsessive-compulsive disorder: a crisis of access.

Nat Med. 2022-8

[4]
The Decline of Deep Brain Stimulation for Obsessive-Compulsive Disorder Following FDA Humanitarian Device Exemption Approval.

Front Surg. 2021-3-12

[5]
Deep brain stimulation versus ablative surgery for treatment-refractory obsessive-compulsive disorder: A meta-analysis.

Acta Psychiatr Scand. 2021-4

[6]
Long-term Outcome of Deep Brain Stimulation of the Ventral Part of the Anterior Limb of the Internal Capsule in a Cohort of 50 Patients With Treatment-Refractory Obsessive-Compulsive Disorder.

Biol Psychiatry. 2021-11-15

[7]
Deep brain stimulation of the subthalamic nucleus in obsessive-compulsives disorders: long-term follow-up of an open, prospective, observational cohort.

J Neurol Neurosurg Psychiatry. 2020-12

[8]
Long-Term Deep Brain Stimulation in Treatment-Resistant Obsessive-Compulsive Disorder: Outcome and Quality of Life at Four to Eight Years Follow-Up.

Neuromodulation. 2021-2

[9]
A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder.

Neurosurgery. 2020-11-16

[10]
Investigating the Role of Glutamate in Obsessive-Compulsive Disorder: Current Perspectives.

Neuropsychiatr Dis Treat. 2020-4-17

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