title: Electrical stimulation of the inferior thalamic peduncle in the treatment of major depression and obsessive compulsive disorders.
abstract: OBJECTIVE
  Stimulation of the inferior thalamic peduncle (ITP) is emerging as a promising new therapeutic target in certain psychiatric disorders. The circuitry that includes the nonspecific thalamic system (NSTS), which projects via the ITP to the orbitofrontal cortex (OFC), is involved in the physiopathology of major depression disorder (MDD) and obsessive compulsive disorder (OCD). The safety and efficacy of chronic ITP stimulation in cases of MDD and OCD refractory to medical treatment is presented.
  
  
  METHODS
  Six patients with OCD and one with MDD were implanted with tetrapolar deep brain stimulation electrodes in the ITP (x = 3.5 mm lateral to the ventricular wall, y = 5 mm behind the anterior commissure, and z = at the intercommissural plane, i.e., anterior commissure-posterior commissure [AC-PC] level). The effect of chronic stimulation at 130 Hz, 450 μs, and 5.0 V on OCD was evaluated before and 3, 6, and 12 months after initiation of electrical stimulation through the Yale-Brown Obsessive Compulsive Scale, Hamilton Depression Rating Scale, and Global Assessment of Function scale.
  
  
  RESULTS
  Chronic ITP electrical stimulation in OCD patients decreased the mean Yale-Brown Obsessive Compulsive Scale score to around 51% for the group at the 12-month follow-up, and increased the mean Global Assessment of Function scale score to 68% for a significant improvement (P = 0.026). Three of 6 patients returned to work. The Hamilton Depression Rating Scale score of the only patient with MDD treated to date went from 42 to 6. This condition of the patient, who had been incapacitated for 5 years prior to surgery, has not relapsed for 9 years. Three OCD patients with drug addiction continued to consume drugs in spite of their improvement in OCD.
  
  
  CONCLUSIONS
  Deep brain stimulation in the ITP is safe and may be effective in the treatment of OCD. A multicenter evaluation of the safety and efficacy of ITP in OCD is currently in process.
authors: Unit for Stereotactic, Functional Neurosurgery and Radiosurgery, Mexico General Hospital, Mexico City, Mexico.
authors: Fiacro
authors: F
authors: Jiménez
authors: Humberto
authors: H
authors: Nicolini
authors: Andres M
authors: AM
authors: Lozano
authors: Fabián
authors: F
authors: Piedimonte
authors: Rafael
authors: R
authors: Salín
authors: Francisco
authors: F
authors: Velasco
mesh_terms: D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000266:history / Q000379:methods*; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004567:Electrodes, Implanted; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy*; D017397:Prefrontal Cortex / Q000502:physiology; D013787:Thalamic Nuclei / Q000502:physiology*; D016896:Treatment Outcome; D055815:Young Adult