title: Unilateral deep brain stimulation of the nucleus accumbens in patients with treatment-resistant obsessive-compulsive disorder: Outcomes after one year.
abstract: 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.
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Germany. wolfgang.huff@uk-koeln.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Huff
authors.forename: Doris
authors.initials: D
authors.lastname: Lenartz
authors.forename: Michael
authors.initials: M
authors.lastname: Schormann
authors.forename: Sun-Hee
authors.initials: SH
authors.lastname: Lee
authors.forename: Jens
authors.initials: J
authors.lastname: Kuhn
authors.forename: Anastosious
authors.initials: A
authors.lastname: Koulousakis
authors.forename: Juergen
authors.initials: J
authors.lastname: Mai
authors.forename: Joerg
authors.initials: J
authors.lastname: Daumann
authors.forename: Mohammad
authors.initials: M
authors.lastname: Maarouf
authors.forename: Joachim
authors.initials: J
authors.lastname: Klosterkötter
authors.forename: Volker
authors.initials: V
authors.lastname: Sturm
mesh_terms: 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