Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

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

Molecular Psychiatry volume 22, pages 931–934 (2017)Cite this article

Subjects

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.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Skoog G, Skoog I . A 40-year follow-up of patients with obsessive-compulsive disorder. Arch Gen Psychiatry 1999; 56: 121–127.

    Article  CAS  PubMed  Google Scholar 

  2. 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.

    Article  CAS  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. Denys D . Pharmacotherapy of obsessive-compulsive disorder and obsessive-compulsive spectrum disorders. Psychiatr Clin N Am 2006; 29: 553–584.

    Article  Google Scholar 

  5. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 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.

  9. 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.

    Article  CAS  PubMed  Google Scholar 

  10. Hamilton M . The assesment of anxiety states by rating. Br J Med Psychol 1959; 32: 50–55.

    Article  CAS  Google Scholar 

  11. 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.

    Article  CAS  Google Scholar 

  12. Hall R . Global assessment of functioning. A modified scale. Psychosomatics 1995; 36: 267–275.

    Article  CAS  PubMed  Google Scholar 

  13. Gueorguieva R, Krystal JH . Move over ANOVA: progress in analyzing repeated-measures data and its reflection. Arch Gen Psychiatry 2004; 61: 310–317.

    Article  PubMed  Google Scholar 

  14. Molenberghs G, Verbeke G . Linear Mixed Models for Longitudinal Data1st edn. Springer: New York, NY, USA, 2000.

    Book  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 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.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

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

Author information

Author notes

  1. K Demyttenaere, L Gabriëls and B Nuttin: These senior authors contributed equally to this work.

Authors and Affiliations

  1. KU Leuven Research Group Psychiatry, Leuven, Belgium

    S Raymaekers, K Vansteelandt & K Demyttenaere

  2. Z.ORG UPC KU Leuven, Leuven, Belgium

    S Raymaekers, K Vansteelandt, C Bervoets, K Demyttenaere & L Gabriëls

  3. KU Leuven Research Group Psychology of Learning and Experimental Psychopathology, Leuven, Belgium

    L Luyten

  4. KU Leuven Research Group Experimental Neurosurgery and Neuroanatomy, Leuven, Belgium

    L Luyten & B Nuttin

  5. UZ Leuven Department of Neurosurgery, Leuven, Belgium

    B Nuttin

Authors
  1. S Raymaekers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K Vansteelandt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L Luyten
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C Bervoets
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K Demyttenaere
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L Gabriëls
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. B Nuttin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S Raymaekers.

Ethics declarations

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.

Additional information

Supplementary Information accompanies the paper on the Molecular Psychiatry website

Supplementary information

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/mp.2016.124

This article is cited by

Search

Advanced search

Quick links