Long-term electrical stimulation of bed nucleus of stria terminalis for obsessive-compulsive disorder

Abstract

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.

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Acknowledgements

We thank the hospital staff, especially John Das, Laurean Matthijs and Els Brunfaut. We also thank all particpating patients and their families.

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Correspondence to S Raymaekers.

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Competing interests

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.

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Supplementary Information accompanies the paper on the Molecular Psychiatry website

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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

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