We previously reported that bilateral electrical stimulation in the anterior limb of the internal capsule/bed nucleus of the stria terminalis (IC/BST) effectively reduces symptoms in severe treatment-resistant obsessive-compulsive disorder (OCD) patients. Here we used a linear mixed model to investigate the evolution of symptomatic and functional status of our patients (n=24) and examined if baseline variables could predict this evolution. Data were collected during routine, clinical psychiatric visits. Our analysis showed a long-term, sustained effect of electrical stimulation in the IC/BST. After a fast initial decline of OCD symptoms, these symptoms remain relatively stable. In addition, we found a strong ON/OFF effect of stimulation (e.g., due to battery depletion). Our data also show that it is not the surgical procedure but rather the electrical stimulation that drives the improvement in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores. The Beck Depression Inventory (BDI) at baseline was the only predictor significantly related to the evolution of the Y-BOCS. A higher BDI at baseline seemed to be related to a smaller decrease of the Y-BOCS over time. In conclusion, electrical stimulation in the IC/BST has a fast and sustained effect on OCD and comorbid symptoms and functional status of patients.
Subscribe to Journal
Get full journal access for 1 year
only $62.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Skoog G, Skoog I . A 40-year follow-up of patients with obsessive-compulsive disorder. Arch Gen Psychiatry 1999; 56: 121–127.
Ruscio AM, Stein DJ, Chiu WT, Kessler RC . The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry 2010; 15: 53–63.
Stein DJ, Koen N, Fineberg N, Fontenelle LF, Matsunaga H, Osser DSH . A 2012 evidence based algorithm for the pharmacotherapy for obsessive compulsive disorder. Curr Psychiatry Rep 2012; 14: 211–219.
Denys D . Pharmacotherapy of obsessive-compulsive disorder and obsessive-compulsive spectrum disorders. Psychiatr Clin N Am 2006; 29: 553–584.
Garnaat S, Greenberg BD, Sibrava NJ, Goodman WK, Mancebo MC, Eisen JL et al. Who qualifies for deep brain stimulation for OCD? Data From a naturalistic clinical sample. J Neuropsychiatry Clin Neurosci 2014; 26: 81–86.
Kohl S, Schönherr DM, Luigjes J, Denys D, Mueller UJ, Lenartz D et al. Deep brain stimulation for treatment-refractory obsessive compulsive disorder: a systematic review. BMC Psychiatry 2014; 14: 214.
Bourne SK, Eckhardt Ca, Sheth Sa, Eskandar EN . Mechanisms of deep brain stimulation for obsessive compulsive disorder: effects upon cells and circuits. Front Integr Neurosci 2012; 6: 29.
Luyten L, Hendrickx S, Raymaekers S, Gabriëls L, Nuttin B . Electrical stimulation in the bed nucleus of the stria terminalis alleviates severe obsessive-compulsive disorder. Mol Psychiatry 2015.
Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989; 46: 1006–1011.
Hamilton M . The assesment of anxiety states by rating. Br J Med Psychol 1959; 32: 50–55.
Beck AT, Steer RA, Ball R, Ranieri W . Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. J Pers Assess 1996; 67: 588–597.
Hall R . Global assessment of functioning. A modified scale. Psychosomatics 1995; 36: 267–275.
Gueorguieva R, Krystal JH . Move over ANOVA: progress in analyzing repeated-measures data and its reflection. Arch Gen Psychiatry 2004; 61: 310–317.
Molenberghs G, Verbeke G . Linear Mixed Models for Longitudinal Data1st edn. Springer: New York, NY, USA, 2000.
Tykocki T, Nauman P, Koziara H, Mandat T . Microlesion effect as a predictor of the effectiveness of subthalamic deep brain stimulation for Parkinson’s disease. Stereotact Funct Neurosurg 2013; 91: 12–17.
Nuttin B, Wu H, Mayberg H, Hariz M, Gabriels L, Galert T et al. Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders. J Neurol Neurosurg Psychiatry 2014; 85: 1003–1008.
Alonso P, Cuadras D, Gabriëls L, Denys D, Goodman W, Greenberg BD et al. Deep brain stimulation for obsessive-compulsive disorder: a meta-analysis of treatment outcome and predictors of response. PLoS One 2015; 10: e0133591.
We thank the hospital staff, especially John Das, Laurean Matthijs and Els Brunfaut. We also thank all particpating patients and their families.
This work was supported by the Research Foundation—Flanders (FWO) Project G072909N, FWO Research Grant (to LL) 1504614 N, and by the Agency for Innovation by Science and Technology (IWT-SBO090054). LL is a postdoctoral fellow of the FWO. All devices were generously provided by Medtronic. They also provided grants for research, education and traveling to BN and LG, who hold the Medtronic Chair for Stereotactic Neurosurgery in Psychiatric Disorders at KU Leuven. SR is supported by this Chair. BN co-owns a patent on DBS in OCD. The remaining authors declare no conflicts of interest.
Supplementary Information accompanies the paper on the Molecular Psychiatry website
About this article
Cite this article
Raymaekers, S., Vansteelandt, K., Luyten, L. et al. Long-term electrical stimulation of bed nucleus of stria terminalis for obsessive-compulsive disorder. Mol Psychiatry 22, 931–934 (2017). https://doi.org/10.1038/mp.2016.124
Improving long term patient outcomes from deep brain stimulation for treatment-refractory obsessive-compulsive disorder
Expert Review of Neurotherapeutics (2020)
The Neuroscientist (2020)
Deep Brain Stimulation for Obsessive Compulsive Disorder: Evolution of Surgical Stimulation Target Parallels Changing Model of Dysfunctional Brain Circuits
Frontiers in Neuroscience (2019)
Nature Reviews Neurology (2019)
The Bed Nucleus of the Stria Terminalis, Homeostatic Satiety, and Compulsions: What Can We Learn From Polydipsia?
Frontiers in Behavioral Neuroscience (2019)