Removing and reimplanting deep brain stimulation therapy devices in resistant OCD (when the patient does not respond): case report

Abstract

Background: Deep brain stimulation (DBS) is emerging as a promising tool in the treatment of refractory obsessive-compulsive disorder (OCD) but the search for the best target still continues. This issue is especially relevant when particularly resistant profiles are observed in some patients, which have been ascribed to individual responses to DBS according to differential patterns of connectivity. As patients have been implanted, new dilemmas have emerged, such as what to do when the patient does not respond to surgery.

Case presentation: Here we describe a 22-year-old male with extremely severe OCD who did not respond to treatment with DBS in the nucleus accumbens, but who did respond after explanting and reimplanting leads targeting the ventral capsule-ventral striatum region. Information regarding the position of the electrodes for both surgeries is provided and possible brain structures affected during stimulation are reviewed. To our knowledge this case is the first in the literature reporting the removal and reimplantation of DBS leads for therapeutical benefits in a patient affected by a mental disorder.

Conclusion: The capability for explantation and reimplantation of leads should be considered as part of the DBS therapy reversibility profile in resistant mental disorders, as it allows application in cases of non-response to the first surgery.

Fig. 1

Anatomical location of the stimulation points and postoperative location of the electrodes on both surgeries. Red dots (A,B,D,E) show the position of the center of the stimulation after the first and second surgery superimposed in Mai atlas*†. a Coronal section 4,2 mm anterior to AC showing the middle point between the two active contacts on the right side after the first surgery. b Coronal section 5,8 mm anterior to AC showing the middle point between the two active contacts on the left side after the first surgery. c Postoperative CT fused with MRI showing the radiological position of the electrodes with respect to anterior comissure after the first surgery. d Coronal section 4,0 mm posterior to AC showing the middle point between the two active contacts on the right side after the second surgery. e Coronal section 2,7 mm posterior to AC showing the middle point between the two active contacts on the left side after the second surgery. f Postoperative CT fused with MRI showing radiological position of the electrodes with respect to anterior comissure after the second surgery. * Images on both sides correspond to frontal sections of left hemispheres of the human brain in Mai atlas. Frontal sections most closely related with anatomical location of the stimulation point have been chosen for the figure. † Elsevier Ltd. granted written permission to use, adapt and publish the images belonging to Atlas of the Human Brain, 3° ed (ISBN 9780123736031), Mai et al.