Deep brain stimulation for treatment of obsessive-compulsive disorder
- Damiaan Denys, MD, PhD
Damiaan Denys, MD, PhD
- Professor of Psychiatry
- Academic Medical Center, University of Amsterdam
- Netherlands Institute for Neuroscience, an institute of the KNAW, Amsterdam
- Pelle P de Koning, MD
Pelle P de Koning, MD
- Department of Psychiatry, Academic Medical Center (AMC),
- University of Amsterdam, Amsterdam, The Netherlands
Obsessive-compulsive disorder (OCD) is a disabling and potentially chronic mental disorder, affecting approximately 2 to 3 percent of the population, and characterized by anxiety-provoking intrusive thoughts and repetitive behaviors.
Effective treatments for OCD include cognitive behavioral therapy (CBT) and serotonin reuptake inhibitors. Even when optimal treatment is provided, however, approximately 10 percent of patients remain severely affected with treatment-refractory OCD . Deep brain stimulation (DBS), a treatment in which implanted electrodes send electrical pulses to specific locations in the brain, may be useful for a small proportion of patients with severe, incapacitating OCD that is refractory to other treatments.
Deep brain stimulation for OCD is discussed here. The epidemiology, clinical manifestations, diagnosis, and treatment of OCD with pharmacotherapy and psychotherapy are discussed separately. OCD in pregnant and postpartum women are also discussed separately. (See "Obsessive-compulsive disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis" and "Psychotherapy for obsessive-compulsive disorder in adults" and "Pharmacotherapy for obsessive-compulsive disorder in adults" and "Obsessive-compulsive disorder in pregnant and postpartum women".)
Deep brain stimulation (DBS) is a neurosurgical treatment involving the implantation of electrodes that send electrical impulses to specific locations in the brain (figure 1) . Widely used in the treatment of advanced movement disorders, DBS has been investigated for treatment-resistant obsessive-compulsive disorder (OCD) since the first case reported in 1999 . DBS provides an adjustable and reversible means of neuromodulation. (See "Surgical treatment of Parkinson disease", section on 'Deep brain stimulation'.)
The location of deep brain stimulation (DBS) is selected according to the type of symptoms of obsessive-compulsive disorder (OCD) to be addressed. Based on published trials and case studies, it is estimated that a total of approximately 250 patients with OCD have received experimental DBS using six different brain targets [2,4,5]:
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- Quality of life
- Concurrent antidepressant effects
- ADVERSE EFFECTS
- Surgical complications
- Hardware complications
- Stimulation related complications
- - Severe depression and anxiety
- - Risk of suicide
- - Hypomania
- - Cognitive dysfunction
- CONCURRENT TREATMENT
- ALTERNATIVE INTERVENTIONS
- SUMMARY AND RECOMMENDATIONS