Deep brain stimulation of the anterior limb of the internal capsule for treatment of therapy-refractory obsessive compulsive disorder (OCD): a case study highlighting neurocognitive and psychiatric changes

Choudhury, Tabina K.; Davidson, Joyce; Viswanathan, Ashwin; Strutt, Adriana M.

doi:10.1080/13554794.2017.1319958

Cited by 8 publications

(4 citation statements)

References 24 publications

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“…ALIC DBS responses appeared to rely on programming adjustments, particularly stimulation amplitude. High intensities up to 8.5 V or 10.5 V were applied for chronic ALIC DBS across all trials with the exception of the most recent investigation [170], and the patient that declined between 4-12 months [179] had a lower stimulation intensity (2-4 V). A case series showed a ceiling effect of clinical response at six months which coincided with optimization of stimulation [180].…”

Section: Ocd Alic Targetmentioning

confidence: 99%

Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review

et al. 2021

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Invasive and noninvasive neurostimulation therapies for obsessive-compulsive and related disorders (OCRD) were systematically reviewed with the aim of assessing clinical characteristics, methodologies, neuroanatomical substrates, and varied stimulation parameters. Previous reviews have focused on a narrow scope, statistical rather than clinical significance, grouped together heterogenous protocols, and proposed inconclusive outcomes and directions. Herein, a comprehensive and transdiagnostic evaluation of all clinically relevant determinants is presented with translational clinical recommendations and novel response rates. Electroconvulsive therapy (ECT) studies were limited in number and quality but demonstrated greater efficacy than previously identified. Targeting the pre-SMA/SMA is recommended for transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). TMS yielded superior outcomes, although polarity findings were conflicting, and refinement of frontal/cognitive control protocols may optimize outcomes. For both techniques, standardization of polarity, more treatment sessions (>20), and targeting multiple structures are encouraged. A deep brain stimulation (DBS) ‘sweet spot’ of the striatum for OCD was proposed, and CBT is strongly encouraged. Tourette’s patients showed less variance and reliance on treatment optimization. Several DBS targets achieved consistent, rapid, and sustained clinical response. Analysis of fiber connectivity, as opposed to precise neural regions, should be implemented for target selection. Standardization of protocols is necessary to achieve translational outcomes.

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Section: Ocd Alic Targetmentioning

confidence: 99%

Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review

et al. 2021

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“…Moreover, deficits in this cognitive domain have been associated with ordering and symmetry symptoms manifested by youth with OCD [62]. Since treatment response has been shown to improve the deficits in processing speed among both pediatric [63] and adult patients [64,65] with OCD, it could be hypothesized that impairments in this cognitive domain represent a modifiable vulnerability marker for OCD across the lifetime. In this sense, a study reported that pathological uncertainty in adult OCD patients underlies deficits in processing speed [66], which suggests that behavioral interventions could improve processing speed skills and consequently benefit children and adolescents at higher risk for the disorder.…”

Section: Discussionmentioning

confidence: 99%

Cognitive performance in children and adolescents at high-risk for obsessive-compulsive disorder

Bernardes¹,

Saraiva²,

Souza³

et al. 2020

BMC Psychiatry

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Background: Cognitive performance has been studied in adults with obsessive-compulsive symptoms (OCS) and in adult relatives of patients with obsessive-compulsive disorder (OCD) Meanwhile, few studies have been conducted with children under the same conditions. This study compared the neurocognitive domains previously associated with dysfunction in OCD, especially visuoconstructive ability, visuospatial memory, executive functions, and intelligence, in children and adolescents at high risk (HR) for OCD (n = 18) and non-OCD controls (NOC) (n = 31). Methods: For the HR group, we considered the first-degree relatives of patients with OCD that present OCS, but do not meet diagnostic criteria for OCD. Psychiatric diagnosis was assessed by experienced clinicians using the Structured Clinical Interview for DSM-IV and OCS severity was measured by the Yale-Brown Obsessive-Compulsive Scale. Neurocognitive assessment was performed with a comprehensive neuropsychological battery. Performance on the cognitive domains was compared between groups using Multivariate Analysis of Variance, whereas performance on the neuropsychological variables was compared between groups using independent t-tests in a cognitive subdomain analysis. Results: The cognitive domain analysis revealed a trend towards significance for impairments in the motor and processing speed domain (p = 0.019; F = 3.12) in the HR group. Moreover, the cognitive subdomain analysis identified a statistically significant underperformance in spatial working memory in the HR group when compared to the NOC group (p = 0.005; t = − 2.94), and a trend towards significance for impairments in non-verbal memory and visuoconstructive tasks in the HR group. Conclusions: Our results suggest impairments in spatial working memory and motor and processing speed in a non-clinical sample of HR participants. Considering the preliminary nature of our findings, further studies investigating these neurocognitive domains as potential predictors of pediatric OCD are warranted.

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“…Even though the tolerability and efficacy of DBS have been shown in a growing number of studies, the total number of OCD patients treated with DBS worldwide is just around 250, and the average sample size of all studies has been reported to be five [18]. The cognitive effects of DBS in patients with OCD has been investigated even less (see Table 4) [1,7,8,12,21,22,24,26,29,31,32,40,47]. Generally, diverse brain targets have been used across studies and sample sizes were also limited, ranging between one and 24 patients.…”

Section: Introductionmentioning

confidence: 99%

Deep brain stimulation in the ALIC-BNST region targeting the bed nucleus of stria terminalis in patients with obsessive–compulsive disorder: effects on cognition after 12 months

et al. 2022

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Purpose The aim of this study was to evaluate cognitive effects 12 months after Deep Brain Stimulation (DBS) of the Bed Nucleus of Stria Terminalis (BNST) in patients with refractory Obsessive–Compulsive Disorder (OCD). Methods Eight patients (5 female; mean ± SD age 36 ± 15) with OCD were included. A neuropsychological test battery covering verbal and spatial episodic memory, executive function, and attention was administered preoperatively and 12 months after surgery. Medical records were used as a source for descriptive data to probe for any changes not covered by standardized checklists and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the primary outcome measure. Results At 12 months, seven patients showed response to DBS: three were full responders (i.e., Y-BOCS ≥ 35% improvement), and four were partial responders (Y-BOCS 25–34% improvement). Relative to baseline, there was a slight decline on visuo-spatial learning (p = 0.027), and improved performance on the Color-Word Interference inhibition/switching subtest (p = 0.041), suggesting improvement in cognitive flexibility. Conclusions DBS in the BNST for treatment refractory OCD generates very few adverse cognitive effects and improves cognitive flexibility after 12 months of stimulation. The improvement in Y-BOCS and the absence of major cognitive side effects support the BNST as a potential target for DBS in severe OCD.

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Deep brain stimulation of the anterior limb of the internal capsule for treatment of therapy-refractory obsessive compulsive disorder (OCD): a case study highlighting neurocognitive and psychiatric changes

Cited by 8 publications

References 24 publications

Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review

Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review

Cognitive performance in children and adolescents at high-risk for obsessive-compulsive disorder

Deep brain stimulation in the ALIC-BNST region targeting the bed nucleus of stria terminalis in patients with obsessive–compulsive disorder: effects on cognition after 12 months

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