Journal
WORLD NEUROSURGERY
Volume 155, Issue -, Pages E168-E176Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.wneu.2021.08.039
Keywords
Deep brain stimulation; Internal capsule; Nucleus accumbens; Obsessive-compulsive disorder; Ventral striatum
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This study demonstrated that deep brain stimulation targeting the nucleus accumbens, internal capsule, and ventral striatum significantly improved symptoms in patients with medication-resistant obsessive-compulsive disorder. Adjustment of the stimulation site based on individual response may optimize treatment outcomes.
BACKGROUND: Deep brain stimulation of the nucleus accumbens, ventral striatum, or internal capsule region has shown a 45%-60% response rate in adults with severe treatment-refractory obsessive-compulsive disorder, regardless of which target is used. We sought to improve the effectiveness of deep brain stimulation by placing the electrode along a trajectory including these 3 targets, enabling a change of stimulation site depending on the patient's response. METHODS: This study used the medical records of 14 pa-tients from 4 different Spanish institutions: 7 from the Hospital Universitario La Princesa, 3 from the Hospital Universitario Central de Asturias, 2 from Hospital Universitario Fundacion Jimenez Diaz, and 2 from Hospital Universitari Son Espases. All patients were operated on under the same protocol. Qualitative and quantitative data were collected. RESULTS: Of 14 patients, 11 showed significant improvement in obsessive-compulsive disorder symptoms, as evident in a reduction double dagger 35% in Yale-Brown Obsessive Compulsive Scale scores following stimulation relative to preoperative scores. Seven patients responded to stimu-lation at the nucleus accumbens (the first area we set for stimulation), whereas 4 patients needed to have the active contact switched to the internal capsule to benefit from stimulation. CONCLUSIONS: Deep brain stimulation of the nucleus accumbens, internal capsule, and ventral striatum significantly benefited our cohort of patients with medication-resistant obsessive-compulsive disorder. Electrode insertion through the 3 main targets might confer additional therapeutic efficacy.
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