Deep Brain Stimulation for Obsessive–Compulsive Disorder: A Long Term Naturalistic Follow Up Study in a Single Institution

Abstract

Introduction: Deep brain stimulation (DBS) is a proven, effective tool in the treatment of movement disorders. Expansion of indications for DBS into the realm of neuropsychiatric disorders, especially obsessive-compulsive disorder (OCD), has gained fervent interest, although data on appropriate clinical utilization remains limited. Methods: A retrospective, naturalistic study followed nine severely affected OCD patients (average YBOCs score before implantation 34.2 ± 2.5) treated with DBS of ventral capsule/ventral striatum, with average follow up of 54.8 months. Results: With chronic stimulation (years), a majority of the patients achieved significant benefits in obsessive-compulsive and depressive symptoms. Six patients experienced periods of OCD remission following implantation. Four of the six responders required more than 12 months to achieve response. Relief of major depressive symptoms occurred in four out of six patients with documented co-morbid depression. Settings required to achieve efficacy were higher than those typically utilized for movement disorders, necessitating increased impulse generator (IPG) battery demand. We found patients benefited from conversion to a rechargeable IPG to prevent serial operations for IPG replacement. For patients with rechargeable IPGs, the repetitive habit of recharging did not appear to aggravate or trigger new obsessive-compulsive behaviors or anxiety symptoms. Conclusions: Our study supports and builds upon other research suggesting that DBS for OCD in a real-world setting can be implemented successfully and provide long-term benefit for severely affected OCD patients. Optimal patient selection and DBS programming criteria are discussed. The use of rechargeable IPGs appears to be both cost effective and well-tolerated in this population.

Elevated activity in the dorsal dentate gyrus reduces expression of fear memory after fear extinction training

“…We found that freezing levels in mice that received DBS in the dDG during fear extinction were significantly lower than in mice from the sham group; DBS may help to suppress fear expression during fear extinction training. Although DBS has been used routinely to treat depression 47 and obsessivecompulsive disorder 48 and preclinical DBS studies in fear conditioning animal models have suggested its potential use for treatment-resistant PTSD, [49][50][51] very few studies have explored the clinical effect of DBS in PTSD. [52][53][54] About 20% to 30% of PTSD patients do not respond to medications and conventional psychotherapy.…”

Neuroimaging evaluation of deep brain stimulation in the treatment of representative neurodegenerative and neuropsychiatric disorders

“…DBS is the most prevalent example of symptomatic interventions in movement disorders and other neurological and psychiatric conditions (McKinnon et al, 2019 , Sullivan et al, 2021 ). Recent developments of long-lasting and rechargeable battery to power implantable pulse generator (IPG) and precise segmental electrodes can improve patient comfort (Holland et al, 2020 ) and enable on-demand delivery of stimulation based on closed-loop designs (Bouthour et al, 2019 ). Stimulation of neuroanatomic targets in central and peripheral nerve systems is believed to modulate neuronal activity locally and remotely in order to restore circuitry involved in normal brain functioning.…”

“…Firstly, IPG had limited battery lives and had to be replaced surgically and reprogrammed after about 5 years. This drawback was mitigated by the development of rechargeable implantable pulse generators to increase patient comfort, reduce long-term cost for DBS and eliminate the surgery for IPG placement (De Vloo et al, 2018 , Hitti et al, 2018 , Holland et al, 2020 ). Secondly, the efficacy of this intervention had been variable depending on accurate placement of electrodes on specific targets and precise setting of stimulation paradigms for each individual patient with a particular disorder.…”

Developing Precision Invasive Neuromodulation for Psychiatry

“…Challenges in optimizing invasive neuromodulation are not unique to depression. Studies of DBS for obsessive-compulsive disorder (OCD) have varied on probe placement and treatment response rates (21)(22)(23)(24). Furthermore, methods for predicting individual likelihood of response are limited.…”