Deep brain stimulation in the bed nucleus of stria terminalis in obsessive-compulsive disorder - 1 year follow up.

Abstract

BACKGROUND\nDeep brain stimulation (DBS) is under investigation as a treatment for therapy-refractory obsessive-compulsive disorder (OCD). As a crucial part of the anxiety circuit the BNST has been proposed as a target for DBS in OCD. Here, we investigate clinical outcomes and safety of DBS in the BNST in a series of 11 participants with severe therapy-refractory OCD.\n\n\nMETHODS\nEleven consecutive participants diagnosed with refractory OCD were treated with BNST DBS and completed follow-up. The primary outcome was change in scores of the Yale Brown Obsessive Compulsive Scale (YBOCS) at one year after surgery. Secondary outcomes included changes in scores of the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Global Assessment of Functioning (GAF).\n\n\nRESULTS\nAt baseline, the mean±SD YBOCS score was 33±3.0, MADRS score was 29±4.5 and GAF score was 49±5.4. One year after DBS, mean±SD YBOCS score was 20±4.8 (38% improvement (range 10-60%) p <0.01), MADRS score was 21±5.8 (30% improvement, range 10-74%, p <0.01) and GAF score 55±6.5 (12% improvement, range 4-29%, p<0.05). Of the 11 participants 6 were considered responders (decrease in YBOCS ≥35%) and 4 partial responders (decrease in YBOCS 25-34%). Surgical adverse events included one case of skin infection leading to re-implantation. The most common transient stimulation related side-effects were anxiety and insomnia.\n\n\nCONCLUSIONS\nBNST DBS is a promising therapy in severe therapy-refractory OCD. Our results are in line with previous publications regarding effect and safety-profile. Nevertheless, DBS for OCD remains an investigational therapy and should therefore be performed in multidisciplinary clinical studies.