Deep brain stimulation in the treatment of obsessive-compulsive disorder

Abstract

Background: Deep brain stimulation (DBS) has emerged as a treatment for severe cases of therapy-refractory obsessive-compulsive disorder (OCD), and promising results have been reported. The literature might, however, be somewhat unclear, considering the different targets used, and due to repeated inclusion of individual patients in multiple publications. The aim of this report was to review the literature on DBS for OCD.

Methods: The modern literature concerning studies conducted on DBS in the treatment of OCD was reviewed.

Results: The results of DBS in OCD have been presented in 25 reports with 130 patients, of which, however, only 90 contained individual patients. Five of these reports included at least 5 individual patients not presented elsewhere. Sixty-eight of these patients underwent implantation in the region of the internal capsule/ventral striatum, including the nucleus accumbens. The target in this region has varied between groups and over time, but the latest results from bilateral procedures in this area have shown a 50% reduction of OCD scores, depression, and anxiety. The subthalamic nucleus has been suggested as an alternative target. Although beneficial effects have been demonstrated, the efficacy of this procedure cannot be decided, because only results after 3 months of active stimulation have been presented so far.

Conclusions: DBS is a promising treatment for therapy-refractory OCD, but the published experience is limited and the method is at present an experimental therapy.

Keywords: CBT; Cognitive-behavioral psychotherapy; DBS; Deep brain stimulation; IC; ITP; Inferior thalamic peduncle; Internal capsule; NA; Nucleus accumbens; OCD; Obsessive-compulsive disorder; PD; Parkinson disease; STN; Stereotaxy; Subthalamic nucleus; VC/VS; Ventral internal capsule/ventral striatum; YBOCS; Yale-Brown Obsessive Compulsive Scale.