title: Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder.
abstract: OBJECTIVE
  Because of the irreversibility of lesioning procedures and their possible side effects, we studied the efficacy of replacing bilateral anterior capsulotomy with chronic electrical capsular stimulation in patients with severe, long-standing, treatment-resistant obsessive-compulsive disorder.
  
  
  METHODS
  We stereotactically implanted quadripolar electrodes in both anterior limbs of the internal capsules into six patients with severe obsessive-compulsive disorder. Psychiatrists and psychologists performed a double-blind clinical assessment. A blinded random crossover design was used to assess four of those patients, who underwent continuous stimulation thereafter.
  
  
  RESULTS
  The psychiatrist-rated Yale-Brown Obsessive Compulsive Scale score was lower in the stimulation-on condition (mean, 19.8 +/- 8.0) than in the postoperative stimulator-off condition (mean, 32.3 +/- 3.9), and this stimulation-induced effect was maintained for at least 21 months after surgery. The Clinical Global Severity score decreased from 5 (severe; standard deviation, 0) in the stimulation-off condition to 3.3 (moderate to moderate-severe; standard deviation, 0.96) in the stimulation-on condition. The Clinical Global Improvement scores were unchanged in one patient and much improved in the other three during stimulation. During the stimulation-off period, symptom severity approached baseline levels in the four patients. Bilateral stimulation led to increased signal on functional magnetic resonance imaging studies, especially in the pons. Digital subtraction analysis of preoperative [(18)F]2-fluoro-2-deoxy-d-glucose positron emission tomographic scans and positron emission tomographic scans obtained after 3 months of stimulation showed decreased frontal metabolism during stimulation.
  
  
  CONCLUSIONS
  These observations indicate that capsular stimulation reduces core symptoms 21 months after surgery in patients with severe, long-standing, treatment-refractory obsessive-compulsive disorder. The stimulation elicited changes in regional brain activity as measured by functional magnetic resonance imaging and positron emission tomography.
authors.affiliation: Department of Neurosurgery, Laboratory of Experimental Neurosurgery and Neuroanatomy, Catholic University of Leuven, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. bart.nuttin@uz.kuleuven.ac.be
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Nuttin
authors.forename: Loes A
authors.initials: LA
authors.lastname: Gabriëls
authors.forename: Paul R
authors.initials: PR
authors.lastname: Cosyns
authors.forename: Björn A
authors.initials: BA
authors.lastname: Meyerson
authors.forename: Sergej
authors.initials: S
authors.lastname: Andréewitch
authors.forename: Stefan G
authors.initials: SG
authors.lastname: Sunaert
authors.forename: Alex F
authors.initials: AF
authors.lastname: Maes
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Dupont
authors.forename: Jan M
authors.initials: JM
authors.lastname: Gybels
authors.forename: Frans
authors.initials: F
authors.lastname: Gielen
authors.forename: Hilde G
authors.initials: HG
authors.lastname: Demeulemeester
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D002908:Chronic Disease; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013238:Stereotaxic Techniques; D013997:Time Factors; D014055:Tomography, Emission-Computed