Unilateral deep brain stimulation of the nucleus accumbens in patients with treatment-resistant obsessive-compulsive disorder: Outcomes after one year.
OBJECTIVE
To investigate the effects of unilateral deep brain stimulation (DBS) in the right nucleus accumbens in patients with obsessive-compulsive disorder (OCD). Predominantly bilateral stimulation of the anterior limb of the internal capsule was utilized.


METHODS
The study was designed as a double-blind sham-controlled crossover study. Patients received 3 months of deep brain stimulation followed by 3 months of sham stimulation, or vice versa. Subsequently, stimulation was continued unblinded for all patients. The primary outcome measure was the severity level of OCD, measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Secondary outcome measures were depressive symptoms, anxiety, psychological symptom severity, global functioning, quality of life, and cognitive function.


RESULTS
The mean Y-BOCS scores decreased significantly from 32.2 (+/-4.0) at baseline to 25.4 (+/-6.7) after 12 months (p=0.012). Five out of ten patients showed a decrease of more than 25%, indicating at least a partial response. One patient showed a decrease in Y-BOCS severity greater than 35%. Similarly, depression, global functioning and quality of life improved within one year. In contrast, anxiety, global symptom severity and cognitive function showed no significant changes. In general, DBS was well-tolerated.


CONCLUSIONS
DBS of the unilateral right nucleus accumbens showed encouraging results in patients with treatment-resistant OCD. Five out of ten patients reached at least a partial response after the first year.
Huff
Wolfgang
W
Department of Psychiatry and Psychotherapy, University of Cologne, Germany. wolfgang.huff@uk-koeln.de
Lenartz
Doris
D
Schormann
Michael
M
Lee
Sun-Hee
SH
Kuhn
Jens
J
Koulousakis
Anastosious
A
Mai
Juergen
J
Daumann
Joerg
J
Maarouf
Mohammad
M
Klosterkötter
Joachim
J
Sturm
Volker
V
D000328:Adult; D001931:Brain Mapping / Q000379:methods; D003071:Cognition; D018592:Cross-Over Studies; D046690:Deep Brain Stimulation / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D007839:Functional Laterality; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009714:Nucleus Accumbens / Q000503:physiopathology*; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D018579:Patient Selection; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome