Deep brain stimulation of the nucleus accumbens and bed nucleus of stria terminalis for obsessive-compulsive disorder: a case series

Abstract

Background: Obsessive-compulsive disorder (OCD) is a psychiatric condition defined by the presence of obsessions, compulsions, or both. It has a lifetime prevalence of 2%-3% and causes significant impairment in social and work functioning, as well as a reduced quality of life. Treatment includes pharmacotherapy and psychotherapy, but a significant number of patients fail to respond to treatment. Deep brain stimulation has shown to be a safe and effective procedure for severe, chronic, treatment-resistant OCD, and several surgical targets have been proposed for treatment, including the nucleus accumbens, the anterior limb of the internal capsule, the subthalamic nucleus, the globus pallidus, and the bed nucleus of stria terminalis.

Objectives: To report the first Italian case series of patients who underwent DBS of 2 distinct targets for OCD: nulceus accumbens and bed nulceus of stria terminalis.

Methods: Four patients underwent DBS of the nulceus accumbens, and 4 patients underwent DBS of the bed nucleus of stria terminalis.

Results: Six patients showed a significant improvement in OCD symptoms.

Conclusions: DBS of these 2 structures is a safe and effective procedure for the treatment of severe, refractory OCD.

Keywords: Bed nucleus stria terminalis; Deep brain stimulation; Nucleus accumbens; Obsessive-compulsive disorder.