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]:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Denys D. Pharmacotherapy of obsessive-compulsive disorder and obsessive-compulsive spectrum disorders. Psychiatr Clin North Am 2006; 29:553.
- de Koning PP, Figee M, van den Munckhof P, et al. Current status of deep brain stimulation for obsessive-compulsive disorder: a clinical review of different targets. Curr Psychiatry Rep 2011; 13:274.
- Nuttin B, Cosyns P, Demeulemeester H, et al. Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet 1999; 354:1526.
- Nair G, Evans A, Bear RE, et al. The anteromedial GPi as a new target for deep brain stimulation in obsessive compulsive disorder. J Clin Neurosci 2014; 21:815.
- Coenen VA, Schlaepfer TE, Goll P, et al. The medial forebrain bundle as a target for deep brain stimulation for obsessive-compulsive disorder. CNS Spectr 2017; 22:282.
- Greenberg BD, Rauch SL, Haber SN. Invasive circuitry-based neurotherapeutics: stereotactic ablation and deep brain stimulation for OCD. Neuropsychopharmacology 2010; 35:317.
- Meissner W, Leblois A, Hansel D, et al. Subthalamic high frequency stimulation resets subthalamic firing and reduces abnormal oscillations. Brain 2005; 128:2372.
- McIntyre CC, Hahn PJ. Network perspectives on the mechanisms of deep brain stimulation. Neurobiol Dis 2010; 38:329.
- Le Jeune F, Vérin M, N'Diaye K, et al. Decrease of prefrontal metabolism after subthalamic stimulation in obsessive-compulsive disorder: a positron emission tomography study. Biol Psychiatry 2010; 68:1016.
- Abelson JL, Curtis GC, Sagher O, et al. Deep brain stimulation for refractory obsessive-compulsive disorder. Biol Psychiatry 2005; 57:510.
- Figee M, de Koning P, Klaassen S, et al. Deep brain stimulation induces striatal dopamine release in obsessive-compulsive disorder. Biol Psychiatry 2014; 75:647.
- Figee M, Luigjes J, Smolders R, et al. Deep brain stimulation restores frontostriatal network activity in obsessive-compulsive disorder. Nat Neurosci 2013; 16:386.
- Miller MH, Wexler MA, Steigbigel NH. Single and combination antibiotic therapy of Staphylococcus aureus experimental endocarditis: emergence of gentamicin-resistant mutants. Antimicrob Agents Chemother 1978; 14:336.
- Goodman WK, Price LH, Rasmussen SA, et al. The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989; 46:1006.
- Skoog G, Skoog I. A 40-year follow-up of patients with obsessive-compulsive disorder [see commetns]. Arch Gen Psychiatry 1999; 56:121.
- Denys D, Mantione M, Figee M, et al. Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Arch Gen Psychiatry 2010; 67:1061.
- Alonso P, Cuadras D, Gabriëls L, et al. Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response. PLoS One 2015; 10:e0133591.
- Mallet L, Polosan M, Jaafari N, et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med 2008; 359:2121.
- Greenberg BD, Gabriels LA, Malone DA Jr, et al. Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry 2010; 15:64.
- Fayad SM, Guzick AG, Reid AM, et al. Six-Nine Year Follow-Up of Deep Brain Stimulation for Obsessive-Compulsive Disorder. PLoS One 2016; 11:e0167875.
- Ooms P, Mantione M, Figee M, et al. Deep brain stimulation for obsessive-compulsive disorders: long-term analysis of quality of life. J Neurol Neurosurg Psychiatry 2014; 85:153.
- Martin JL, Barbanoj MJ, Schlaepfer TE, et al. Transcranial magnetic stimulation for treating depression. Cochrane Database Syst Rev 2002; :CD003493.
- Fitzgerald PB, Brown TL, Marston NA, et al. Transcranial magnetic stimulation in the treatment of depression: a double-blind, placebo-controlled trial. Arch Gen Psychiatry 2003; 60:1002.
- Pahwa R, Factor SA, Lyons KE, et al. Practice Parameter: treatment of Parkinson disease with motor fluctuations and dyskinesia (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2006; 66:983.
- Appleby BS, Duggan PS, Regenberg A, Rabins PV. Psychiatric and neuropsychiatric adverse events associated with deep brain stimulation: A meta-analysis of ten years' experience. Mov Disord 2007; 22:1722.
- Schlaepfer TE, Bewernick BH, Kayser S, et al. Deep brain stimulation of the human reward system for major depression--rationale, outcomes and outlook. Neuropsychopharmacology 2014; 39:1303.
- Kubu CS, Malone DA, Chelune G, et al. Neuropsychological outcome after deep brain stimulation in the ventral capsule/ventral striatum for highly refractory obsessive-compulsive disorder or major depression. Stereotact Funct Neurosurg 2013; 91:374.
- Mantione M, Nieman D, Figee M, et al. Cognitive effects of deep brain stimulation in patients with obsessive-compulsive disorder. J Psychiatry Neurosci 2015; 40:378.
- Blom RM, Figee M, Vulink N, Denys D. Update on repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: different targets. Curr Psychiatry Rep 2011; 13:289.
- 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