Deep brain stimulation for treatment‐refractory obsessive‐compulsive disorder: psychopathological and neuropsychological outcome in three cases

Gabriëls, Lutgardis; Cosyns, Paul; Nuttin, Bart; Demeulemeester, Hilde; Gybels, Jan

doi:10.1034/j.1600-0447.2003.00066.x

Cited by 277 publications

(144 citation statements)

References 29 publications

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“…This study, in agreement with Nuttin et al's (2003) study of long-term effects in four OCD patients, suggests that DBS at the VC/VS target is associated with long-term improvement in symptomatology and functioning in OCD patients with chronic severe illness, who had failed to respond to behavior therapy and medication. We found that OCD improved from the severe illness at baseline (required by our entry criteria) to a mean score reflecting moderate illness during DBS extending over 3 years.…”

Section: Discussionsupporting

confidence: 88%

“…There were no significant performance declines at the group level. Overall, the results suggest that the cognitive adverse event burden of DBS for OCD at this target and parameters is relatively benign (Kubu et al, in preparation), similar to effects observed in the Belgian series (Gabriels et al, 2003).…”

Section: Adverse Effectssupporting

confidence: 69%

“…We think, however, that an insertion effect is very unlikely, as OCD symptoms and functional status were essentially unchanged after implantation but before DBS started. Moreover, symptomatic improvements during VC/ VS DBS were not maintained during masked stimulation withdrawal in one study (Gabriels et al, 2003). Furthermore, stimulation interruption owing to battery depletion, which was not known in advance by patients or investigators, and not detectable by patients (thus essentially masked), was regularly associated with symptom worsening in both the Belgian series (Nuttin et al, 2003b) and here.…”

Section: Limitationsmentioning

confidence: 72%

“…Therapeutic options in this group were previously limited to ablative surgery, such as anterior capsulotomy (see review by Greenberg et al, 2003) or anterior cingulotomy (Dougherty et al, 2002). Beginning with the work of Nuttin et al, small-scale controlled (Nuttin et al, 1999(Nuttin et al, , 2003bGabriels et al, 2003;Abelson et al, 2005) and open studies (Anderson and Ahmed, 2003;Aouizerate et al, 2004;Sturm et al, 2003;Aouizerate et al, 2005) have suggested that deep brain stimulation (DBS) of the internal capsule and/or the adjacent ventral striatal region may be of benefit to severely affected OCD patients who have exhausted conventional therapies. The implantation sites were all generally similar to those for anterior capsulotomy lesions, but the specific targets, surgical approaches, and electrode designs have varied.…”

Section: Introductionmentioning

confidence: 99%

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Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder

Greenberg

Malone

Friehs

et al. 2006

Neuropsychopharmacol

723

436

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Deep brain stimulation (DBS) of the anterior limb of the internal capsule has been shown to be beneficial in the short term for obsessive-compulsive disorder (OCD) patients who exhaust conventional therapies. Nuttin et al, who published the first DBS for OCD series, found promising results using a capsule target immediately rostral to the anterior commissure extending into adjacent ventral capsule/ventral striatum (VC/VS). Published long-term outcome data are limited to four patients. In this collaborative study, 10 adult OCD patients meeting stringent criteria for severity and treatment resistance had quadripolar stimulating leads implanted bilaterally in the VC/VS. DBS was activated openly 3 weeks later. Eight patients have been followed for at least 36 months. Group Yale-Brown Obsessive Compulsive Scale (YBOCS) scores decreased from 34.670.6 (mean7SEM) at baseline (severe) to 22.372.1 (moderate) at 36 months (po0.001). Four of eight patients had a X35% decrease in YBOCS severity at 36 months; in two patients, scores declined between 25 and 35%. Global Assessment of Functioning scores improved from 36.671.5 at baseline to 53.872.5 at 36 months (po0.001). Depression and anxiety also improved, as did self-care, independent living, and work, school, and social functioning. Surgical adverse effects included an asymptomatic hemorrhage, a single seizure, and a superficial infection. Psychiatric adverse effects included transient hypomanic symptoms, and worsened depression and OCD when DBS was interrupted by stimulator battery depletion. This open study found promising long-term effects of DBS in highly treatment-resistant OCD.

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Section: Discussionsupporting

confidence: 88%

Section: Adverse Effectssupporting

confidence: 69%

Section: Limitationsmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

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Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder

Greenberg

Malone

Friehs

et al. 2006

Neuropsychopharmacol

723

436

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“…In addition, DBS shows promise in the treatment of epilepsy (Hodaie et al, 2002), obsessive-compulsive disorder (Gabriels et al, 2003), and depression (Mayberg et al, 2005). However, the clinical successes of DBS are tempered by our limited understanding of the effects of DBS on the nervous system.…”

Section: Introductionmentioning

confidence: 99%

Sources and effects of electrode impedance during deep brain stimulation

Butson

Maks

McIntyre

2006

Clinical Neurophysiology

320

281

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Objective-Clinical impedance measurements for deep brain stimulation (DBS) electrodes in human patients are normally in the range 500-1500 Ω. DBS devices utilize voltage-controlled stimulation; therefore, the current delivered to the tissue is inversely proportional to the impedance. The goals of this study were to evaluate the effects of various electrical properties of the tissue medium and electrode-tissue interface on the impedance and to determine the impact of clinically relevant impedance variability on the volume of tissue activated (VTA) during DBS.Methods-Axisymmetric finite-element models (FEM) of the DBS system were constructed with explicit representation of encapsulation layers around the electrode and implanted pulse generator. Impedance was calculated by dividing the stimulation voltage by the integrated current density along the active electrode contact. The models utilized a Fourier FEM solver that accounted for the capacitive components of the electrode-tissue interface during voltagecontrolled stimulation. The resulting time-and space-dependent voltage waveforms generated in the tissue medium were superimposed onto cable model axons to calculate the VTA.Results-The primary determinants of electrode impedance were the thickness and conductivity of the encapsulation layer around the electrode contact and the conductivity of the bulk tissue medium. The difference in the VTA between our low (790 Ω) and high (1244 Ω) impedance models with typical DBS settings (−3 V, 90 μs, 130 Hz pulse train) was 121 mm 3 , representing a 52% volume reduction.Conclusions-Electrode impedance has a substantial effect on the VTA and accurate representation of electrode impedance should be an explicit component of computational models of voltage-controlled DBS.Significance-Impedance is often used to identify broken leads (for values >2000 Ω) or short circuits in the hardware (for values <50 Ω); however, clinical impedance values also represent an important parameter in defining the spread of stimulation during DBS.

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Scientific and Ethical Issues Related to Deep Brain Stimulation for Disorders of Mood, Behavior, and Thought

Rabins¹,

Appleby²,

Brandt³

et al. 2009

Arch Gen Psychiatry

151

105

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A two-day consensus conference was held in order to examine scientific and ethical issues in the application of deep brain stimulation in the treatment of mood and behavioral disorders such as major depression, obsessive-compulsive disorder, and Tourette syndrome. The primary objectives of the conference were to 1) establish consensus among participants about the design of future clinical trials of DBS for disorders of mood, behavior and thought and 2) develop standards for the protection of human subjects participating in such studies. Conference participants identified 16 key points for guiding research in this growing field.

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Deep brain stimulation for treatment‐refractory obsessive‐compulsive disorder: psychopathological and neuropsychological outcome in three cases

Abstract: These preliminary findings demonstrate that DBS may have important therapeutic benefits on psychopathology in OCD. No harmful side-effects were detected during follow-up (33/33/39 months, respectively).

Cited by 277 publications

References 29 publications

Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder

Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder

Sources and effects of electrode impedance during deep brain stimulation

Scientific and Ethical Issues Related to Deep Brain Stimulation for Disorders of Mood, Behavior, and Thought

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