Surgical Neuroanatomy and Programming in Deep Brain Stimulation for Obsessive Compulsive Disorder

Abstract

Objectives Deep brain stimulation (DBS) has been established as a safe, effective therapy for movement disorders (Parkinson’s disease, essential tremor, etc.), and its application is expanding to the treatment of other intractable neuropsychiatric disorders including Depression and Obsessive-Compulsive Disorder (OCD). Several published studies have supported the efficacy of DBS for severely debilitating OCD. However, questions remain regarding the optimal anatomical target and the lack of a bedside programming paradigm for OCD DBS. Management of OCD DBS can be highly variable and is typically guided by each center’s individual expertise. In this paper, we review the various approaches to targeting and programming for OCD DBS. We also review the clinical experience for each proposed target, and discuss the relevant neuroanatomy. Methods A PubMed review was performed searching for literature on OCD DBS and included all articles published before March 2012. We included all available studies with a clear description of the anatomical targets, programming details, and the outcomes. Results Six different DBS approaches were identified. High frequency stimulation with high voltage was applied in most cases, and predictive factors for favorable outcomes were discussed in the literature. Conclusion DBS remains an experimental treatment for medication refractory OCD. Target selection and programming paradigms are not yet standardized, though, an improved understanding of the relationship between the DBS lead and the surrounding neuroanatomical structures will aid in the selection of targets and the approach to programming. We propose to form a registry to track OCD DBS cases for future clinical study design.

Deep Brain Stimulation for Treatment-resistant Depression: Systematic Review of Clinical Outcomes

“…Given this possibility, the extraordinary public health burden associated with MDD, and the promising results of the open-label trials, further investigation of the potential of DBS for the treatment of MDD is warranted, but care should be taken to optimize trials and methodology as much as possible, and to maximize the consistency of outcomes measurement in order to learn as much as possible from each trial. We propose to form a registry for future clinical studies similar to the one used in the OCD DBS literature [12,76]. Variables should be consistently recorded, and include: 1) detailed clinical characteristics, including accurate diagnosis (e.g., MDD, bipolar disorder), various comorbidities and past response to medical and other treatments, etc.…”

Smile without euphoria induced by deep brain stimulation: a case report

“…First, a DBS electrode (Medtronic, model 3387, Minneapolis, MN, USA) was implanted in the VC/VS area based on our previously published procedure for OCD DBS ( Figure 2) Morishita et al, 2014). Macrostimulation was then performed.…”

Deep brain stimulation for movement disorders: update on recent discoveries and outlook on future developments

“…Major achievements have been accomplished using chronic stimulation of the thalamus for patients with tremor disorders, the subthalamic nucleus (STN) and the globus pallidus internus (GPi) for advanced Parkinson's disease (PD), and the GPi for patients with hyperkinetic movement disorders in particular dystonia [1][2][3]. While there is also great interest in the use of DBS in the treatment of other neurological conditions such as chronic pain [4,5] and medically refractory psychiatric/behavioral conditions such as obsessive compulsive disorder [6][7][8] or depression [9,10], these will not be discussed here. Instead this article aims to provide an update on the current uses of DBS in its therapeutic and experimental indications in movement disorder patients, including discussion of the optimal timing of its implementation, insights into some of the side effects that DBS may induce and how these may be overcome, and some of the recent advances in DBS technology and how these may help improve outcomes for patients.…”