Deep brain stimulation for refractory obsessive-compulsive disorder

doi:10.1016/j.biopsych.2004.11.042

Biological Psychiatry

Volume 57, Issue 5, 1 March 2005, Pages 510-516

https://doi.org/10.1016/j.biopsych.2004.11.042 Get rights and content

Background

Neurosurgery (anterior capsulotomy) has been beneficial to many patients with debilitating, refractory obsessive-compulsive disorder (OCD), but the irreversibility of the procedure is an important limitation to its use. Nondestructive, electrical stimulation (deep brain stimulation; DBS) has proven an effective alternative to ablative surgery for neurological indications, suggesting potential utility in place of capsulotomy for OCD.

Methods

The effects of DBS for OCD were examined in four patients in a short-term, blinded, on-off design and long-term, open follow-up. The patients had incapacitating illness, refractory to standard treatments. Hardware developed for movement disorder treatment was surgically implanted, with leads placed bilaterally in the anterior limbs of their internal capsules. Patients received stimulation in a randomized “on-off” sequence of four 3-week blocks. Ongoing, open stimulation was continued in consenting patients after the controlled trial.

Results

Patients tolerated DBS well. Dramatic benefits to mood, anxiety, and OCD symptoms were seen in one patient during blinded study and open, long-term follow-up. A second patient showed moderate benefit during open follow-up.

Conclusions

It appears that DBS has potential value for treating refractory psychiatric disorders, but additional development work is needed before the procedure is utilized outside of carefully controlled research protocols.

Section snippets

Entry criteria and measures

This study was reviewed and approved by the University of Michigan Institutional Review Board. In addition, the protocol was granted an Investigational Device Exemption by the U.S. Food and Drug Administration. Entry criteria included Yale-Brown Obsessive Compulsive Scale (Y-BOCS; Goodman et al 1989a, 1989b) score of at least 25; Global Assessment of Function (GAF; Endicott et al 1976) score of no more than 44; multiple unsuccessful attempts at treatment with antiobsessional medication at

Subjects

Subject characteristics are presented in Table 1. Nonessential details have been changed to shield identity.

Exploratory testing

Side effects and symptom responses during exploratory testing are presented in Table 2. along with parameter settings chosen for the blinded test phase. Side effects were most prominent at high amplitudes and monopolar settings. The only acute symptom responses noted occurred in subject 3. She experienced a striking episode of elevated mood and increased activity, occurring at both

Discussion

This preliminary effort at a double-blind, controlled trial of DBS for treatment-refractory OCD produced favorable results. One of four patients (25%) showed a greater than 35% improvement in OCD symptoms during the double-blind testing phase. Two of four (50%) showed this level of improvement during the open phase. These results are comparable to those achieved with ablative, anterior capsulotomy (Mindus et al 1994), which has not been amenable to study in blinded protocols. These results

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Original articlesDeep brain stimulation for refractory obsessive-compulsive disorder

Background

Methods

Results

Conclusions

Section snippets

Entry criteria and measures

Subjects

Exploratory testing

Discussion

Curr Opin Neurobiol

Neurosurg Clin North Am

Neurosurg Clin North Am

Psychiatr Clin North Am

Lancet

Neurosurg Clin North Am

Neuropsychopharmacology

Treatment of patients with intractable obsessive-compulsive disorder with anterior capsular stimulation. Case report

J Neurosurg

Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder

Arch Gen Psychiatry

Cerebral glucose metabolic rates in nondepressed patients with obsessive-compulsive disorder

Am J Psychiatry

Long term results of stereotactic anterior capsulotomy in chronic obsessive-compulsive neurosis

The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance

Arch Gen Psychiatry

Deep brain stimulation for treatment-refractory obsessive-compulsive disorderPsychopathological and neuropsychological outcome in three cases

Acta Psychiatr Scand

The Yale-Brown Obsessive Compulsive Scale. II. Validity

Arch Gen Psychiatry

The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability

Arch Gen Psychiatry

Update on deep brain stimulation

J ECT

Refractory obsessive-compulsive disorderstate-of-the-art treatment

J Clin Psychiatry

Original articles
Deep brain stimulation for refractory obsessive-compulsive disorder