Cognitive Outcome After Deep Brain Stimulation for Refractory Obsessive–Compulsive Disorder: A Systematic Review

Vlis, Tim A. M. Bouwens van der; Duits, Annelien; Veerdonk, Mégan M.G.H. van de; Mulders, Anne E.P.; Schruers, Koen; Temel, Yasin; Ackermans, Linda; Leentjens, Albert F.G.

doi:10.1111/ner.13534

Cited by 5 publications

(4 citation statements)

References 34 publications

(76 reference statements)

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“…Whether this heat map is relevant for cognitive outcomes following STN DBS for other conditions, such as obsessive compulsive disorder, requires future study. 38 …”

Section: Discussionmentioning

confidence: 99%

A brain network for deep brain stimulation induced cognitive decline in Parkinson’s disease

Reich

Hsu

Ferguson

et al. 2022

Brain

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Deep brain stimulation (DBS) is an effective treatment for Parkinson’s disease but can be complicated by side-effects such as cognitive decline. There is often a delay before this side-effect is apparent and the mechanism is unknown, making it difficult to identify patients at risk or select appropriate DBS settings. Here, we test whether connectivity between the stimulation site and other brain regions is associated with cognitive decline following DBS. First, we studied a unique patient cohort with cognitive decline following subthalamic DBS for Parkinson’s disease (n = 10) where re-programming relieved the side-effect without loss of motor benefit. Using resting state functional connectivity data from a large normative cohort (n = 1000), we computed connectivity between each stimulation site and the subiculum, an a priori brain region functionally connected to brain lesions causing memory impairment. Connectivity between DBS sites and this same subiculum region was significantly associated with DBS induced cognitive decline (P < 0.02). We next performed a data-driven analysis to identify connnections most associated with DBS induced cognitive decline. DBS sites causing cognitive decline (versus those that did not) were more connected to the anterior cingulate, caudate nucleus, hippocampus, and cognitive regions of the cerebellum (Pfwe< 0.05). The spatial topography of this DBS-based circuit for cognitive decline aligned with an a priori lesion-based circuit for memory impairment (P = 0.017). To begin translating these results into a clinical tool that might be used for DBS programming, we generated a “heatmap” in which the intensity of each voxel reflects the connectivity to our cognitive decline circuit. We then validated this heatmap using an independent dataset of PD patients in which cognitive performance was measured following subthalamic DBS (n = 33). Intersection of DBS sites with our heatmap was correlated with changes in the Mattis dementia rating scale one year after lead implantation (r = 0.39; p = 0.028). Finally, to illustrate how this heatmap might be used in clinical practice, we present a case that was flagged as “high risk” for cognitive decline based on intersection of the patient’s DBS site with our heatmap. This patient had indeed experienced cognitive decline and our heatmap was used to select alternative DBS parameters. At 14 days follow-up the patient’s cognition improved without loss of motor benefit. These results lend insight into the mechanism of DBS induced cognitive decline and suggest that connectivity-based heatmaps may help identify patients at risk and who might benefit from DBS reprogramming.

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“…Whether this heat map is relevant for cognitive outcomes following STN DBS for other conditions, such as obsessive compulsive disorder, requires future study. 38 …”

Section: Discussionmentioning

confidence: 99%

A brain network for deep brain stimulation induced cognitive decline in Parkinson’s disease

Reich

Hsu

Ferguson

et al. 2022

Brain

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“…The results of many studies have confirmed the impairment of visual (18,26), verbal memory (27), and executive function (28)(29)(30) in OCD patients compared to healthy controls.…”

Section: Discussionmentioning

confidence: 80%

“…Neurocognitive studies which consider memory processes and their biological relationships have demonstrated that frontal association cortex lesions could be the cause of disruption in various aspects of encoding and retrieval in episodic memory (14). Therefore, memory defects have been attributed to neurocognitive impairment in patients with OCD (4,5,12,(15)(16)(17)(18). Some studies evaluated the neuropsychological performance of OCD patients and related these findings to cortical functions.…”

Section: Introductionmentioning

confidence: 99%

Episodic Memory in Obsessive-Compulsive Disorder: Comparison with Healthy Controls

et al. 2023

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Background: Obsessive-compulsive disorder is identified by intrusive thoughts and related compulsive behaviors. Memory complaints are controversial among obsessive-compulsive disorder patients. Objectives: The present study compared verbal, visual, episodic, and semantic memory between obsessive-compulsive disorder patients and healthy controls. Methods: This is a case-control study. The participants included 31 newly diagnosed obsessive-compulsive disorder outpatients and 30 healthy controls. The patients were selected using targeted sampling from Emam Reza Polyclinic, affiliated with blinded for peer review. They responded to a demographic checklist, structured clinical interview for DSM-IV (SCID-I), verbal and visual episodic memory from the Wechsler Memory Scale-Revised (WMS-R), and autobiographical memory interview (AMI). Results: The results indicated that patients with obsessive-compulsive disorder compared with the controls had lower scores in visual (P = 0.0001), verbal (P = 0.006), semantic (P = 0.3), and episodic memory (P = 0.001). Conclusions: All types of memory which were evaluated in the present study were impaired in obsessive-compulsive disorder. Memory impairment might explain the psychiatric symptoms of the disorder.

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“…Meanwhile, they observed that DBS increased social interaction and decreased social avoidance in an ASD rat model [18] . In addition, study associated with DBS applied in other psychiatric disorders suggested that DBS could improve attention, memory and executive functioning [5] . Prospective studies with a standardized neuropsychological assessment battery should be performed to analyze the e cacy of stereotactic neurosurgery in the core symptoms of ASD.…”

Section: Discussionmentioning

confidence: 99%

The role of stereotactic neurosurgery as a symptomatic treatment for autism spectrum disorders: a systematic review

Shi

et al. 2022

Preprint

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Although stereotactic neurosurgery has been applied in autism spectrum disorders (ASD), its safety and efficacy remain elusive due to the limited sample size. We aimed to investigate the safety and efficacy of stereotactic neurosurgery for ASD by systematically reviewing the literature through the PubMed, EMBASE and Cochrane databases. A total of 11 studies with 36 patients were included. 16 patients (44.44%) received deep brain stimulation (DBS), 10 patients (27.78%) underwent radiofrequency ablation (RA), and 10 patients (27.78%) underwent gamma knife radiosurgery and RA. The therapeutic targets of 11 patients (42.31%) were the amygdala, and the surgical indication of 10 patients was aggression; the ventral anterior limb of the internal capsule or medial forebrain bundle was regarded as the target for 6 patients (23.08%), and the surgical indication was OCD. The mean Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) score of 19 patients was 31.37 at baseline. After a median follow-up time of 48 months, the mean Y-BOCS score decreased to 18.32, and the mean improvement rate was 42.74%. After a median follow-up duration of 48 months (range: 2-120), the mean Overt Aggression Scale score of 15 patients was reduced from 11.20 to 4.40, and the mean improvement rate was 59.59%. There were a total of 8 patients whose cardinal symptoms benefited from the surgery. Seven patients (19.44%) suffered adverse events after stereotactic neurosurgery. Stereotactic neurosurgery is an effective and safe therapy to alleviate the symptoms of aggressive behaviors and OCD in ASD patients. DBS has the potential to improve the social contact difficulty and communication disorders of ASD.

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Cognitive Outcome After Deep Brain Stimulation for Refractory Obsessive–Compulsive Disorder: A Systematic Review

Cited by 5 publications

References 34 publications

A brain network for deep brain stimulation induced cognitive decline in Parkinson’s disease

A brain network for deep brain stimulation induced cognitive decline in Parkinson’s disease

Episodic Memory in Obsessive-Compulsive Disorder: Comparison with Healthy Controls

The role of stereotactic neurosurgery as a symptomatic treatment for autism spectrum disorders: a systematic review

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