Preliminary study in patients with obsessive-compulsive disorder treated with electrical stimulation in the inferior thalamic peduncle.
OBJECTIVE
Deep brain stimulation has been used in the treatment of refractory obsessive-compulsive disorder (OCD). Our principal objective was to determine the safety and effectiveness of deep brain stimulation of the inferior thalamic peduncle in the treatment of refractory OCD.


METHODS
An open protocol was performed from March 2003 to April 2007 in 5 patients with OCD refractory to conventional treatments. Bilateral stereotactic implantation of tetrapolar electrodes was aimed at the inferior thalamic peduncle and corroborated by electrophysiological responses and magnetic resonance imaging. All patients were off stimulation for 1 month after implantation. In the on-stimulation period, parameters were set at 5 V, 450 microseconds, 130 Hz in bipolar and continuous mode. Clinical changes were evaluated every 3 months for 12 months by means of the Yale-Brown Obsessive Compulsive Scale and the Global Assessment of Functioning scale. Statistical significance was assessed by the Friedman and Wilcoxon tests.


RESULTS
The mean Yale-Brown Obsessive Compulsive Scale score decreased from 35 to 17.8 (P < 0.001), and the mean Global Assessment of Functioning scale score improved from 20% to 70% (P < 0.0001). The neuropsychological battery did not show significant changes, and there were no side effects related to electrical stimulation in the chronic period.


CONCLUSIONS
We conclude that inferior thalamic peduncle stimulation is a safe procedure and may be an effective alternative in the treatment of those OCD cases refractory to conventional treatments.
Jiménez-Ponce
Fiacro
F
Unit of Stereotactic, Functional Neurosurgery and Radiosurgery, General Hospital of Mexico, Mexico City, Mexico. fiacroj@yahoo.com
Velasco-Campos
Francisco
F
Castro-Farfán
Guillermo
G
Nicolini
Humberto
H
Velasco
Ana Luisa
AL
Salín-Pascual
Rafael
R
Trejo
David
D
Criales
José Luis
JL
D000328:Adult; D000368:Aged; D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000379:methods*; D004185:Disability Evaluation; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D020646:Intralaminar Thalamic Nuclei / Q000033:anatomy & histology / Q000503:physiopathology; D008032:Limbic System / Q000033:anatomy & histology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020644:Midline Thalamic Nuclei / Q000033:anatomy & histology / Q000503:physiopathology; D009434:Neural Pathways / Q000033:anatomy & histology / Q000503:physiopathology; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D017397:Prefrontal Cortex / Q000033:anatomy & histology / Q000503:physiopathology; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000033:anatomy & histology* / Q000503:physiopathology*; D016896:Treatment Outcome; D055815:Young Adult