World neurosurgery | 2021
Deep brain stimulation of the nucleus accumbens, ventral striatum or internal capsule targets for medication resistant obsessive compulsive disorder: a multicentric study.
Abstract
OBJECTIVE\nDeep brain stimulation (DBS) of the nucleus accumbens (NAc), ventral striatum (VS) or internal capsule (IC) region has shown a 45-60% response rate in adults with severe treatment-refractory obsessive-compulsive disorder (OCD), irrespective of which target is used. We sought to improve the effectiveness of DBS by placing the electrode along a trajectory including these three targets, enabling a change of stimulation site depending on the patient s response.\n\n\nMATERIALS AND METHODS\nWe report the medical records of 14 patients from four different Spanish institutions: seven from the University Hospital La Princesa, three from the University Hospital Central de Asturias, two from Fundación Jiménez Díaz and two from University Hospital Son Espases. All patients were operated on under the same protocol. Qualitative and quantitative data were collected.\n\n\nRESULTS\nOut of the 14 patients, 11 showed significant improvement in their OCD symptoms, as evident in a reduction ≥ 35% in their YBOCS scores following stimulation, relative to preoperative scores. Seven patients responded to stimulation at the NAc (the first area we set for stimulation), while four patients needed to have the active contact switched to the IC to benefit from stimulation.\n\n\nCONCLUSIONS\nDBS of the NAc, IC and VS significantly benefited our cohort of patients with medication-resistant OCD. Electrode insertion through the three main targets might confer additional therapeutic efficacy.