Special Section Honoring the Contributions of David S Segal

Neuropsychopharmacology (2006) 31, 2384–2393. doi:10.1038/sj.npp.1301165; published online 19 July 2006

Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder

Benjamin D Greenberg1,2, Donald A Malone3,4, Gerhard M Friehs1,2, Ali R Rezai3,4, Cynthia S Kubu3,4, Paul F Malloy1,2, Stephen P Salloway1,2, Michael S Okun5,6, Wayne K Goodman5,6 and Steven A Rasmussen1,2

  1. 1Departments of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital and Rhode Island Hospital, Providence, RI, USA
  2. 2Department of Clinical Neurosciences (Neurosurgery Division), Brown Medical School, Butler Hospital and Rhode Island Hospital, Providence, RI, USA
  3. 3Department of Psychiatry, Cleveland Clinic Foundation, Cleveland, OH, USA
  4. 4Center for Neurological Restoration, Cleveland Clinic Foundation, Cleveland, OH, USA
  5. 5Departments of Psychiatry and Neurology, University of Florida, Gainesville, FL, USA
  6. 6Movement Disorders Center, University of Florida, Gainesville, FL, USA

Correspondence: Dr BD Greenberg, Departments of Psychiatry and Human Behavior, Brown Medical School, Butler Hospital and Rhode Island Hospital, 345 Blackstone Blvd., Providence, RI 02906 USA, Tel: +1 401 455 6602, Fax: +1 401 455 6442; E-mail: bgreenberg@butler.org

Received 24 January 2006; Revised 2 May 2006; Accepted 11 May 2006; Published online 19 July 2006.

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Abstract

Deep brain stimulation (DBS) of the anterior limb of the internal capsule has been shown to be beneficial in the short term for obsessive–compulsive disorder (OCD) patients who exhaust conventional therapies. Nuttin et al, who published the first DBS for OCD series, found promising results using a capsule target immediately rostral to the anterior commissure extending into adjacent ventral capsule/ventral striatum (VC/VS). Published long-term outcome data are limited to four patients. In this collaborative study, 10 adult OCD patients meeting stringent criteria for severity and treatment resistance had quadripolar stimulating leads implanted bilaterally in the VC/VS. DBS was activated openly 3 weeks later. Eight patients have been followed for at least 36 months. Group Yale-Brown Obsessive Compulsive Scale (YBOCS) scores decreased from 34.6plusminus0.6 (meanplusminusSEM) at baseline (severe) to 22.3plusminus2.1 (moderate) at 36 months (p<0.001). Four of eight patients had a greater than or equal to35% decrease in YBOCS severity at 36 months; in two patients, scores declined between 25 and 35%. Global Assessment of Functioning scores improved from 36.6plusminus1.5 at baseline to 53.8plusminus2.5 at 36 months (p<0.001). Depression and anxiety also improved, as did self-care, independent living, and work, school, and social functioning. Surgical adverse effects included an asymptomatic hemorrhage, a single seizure, and a superficial infection. Psychiatric adverse effects included transient hypomanic symptoms, and worsened depression and OCD when DBS was interrupted by stimulator battery depletion. This open study found promising long-term effects of DBS in highly treatment-resistant OCD.

Keywords:

deep brain stimulation, obsessive–compulsive disorder, internal capsule, long-term treatment, neurosurgery

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