title: Bilateral deep brain stimulation of the nucleus accumbens for comorbid obsessive compulsive disorder and Tourette's syndrome.
abstract: We present the case of a 32-year-old Caucasian woman with severe treatment-refractory obsessive compulsive disorder (OCD) and Tourette's syndrome. Both conditions were present prior to age 5 and impacted significantly on the patient's functioning. Multiple trials of evidence-based pharmacological and behavioural therapies had not achieved remission of symptoms. Bilateral deep brain stimulation of the nucleus accumbens was undertaken to treat both illnesses but with a particular focus on OCD, as the patient identified this as the more debilitating of the two disorders. Following surgery there was an immediate improvement in OCD and tic severity. At follow-up 8&emsp14;months later, there was a 90% improvement in OCD symptoms and a 57% improvement in tic severity. No intraoperative or postoperative complications or adverse events occurred and there were no undesired effects of stimulation.
authors.affiliation: Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Randwick, New South Wales, Australia. p.sachdev@unsw.edu.au
authors.forename: Perminder Singh
authors.initials: PS
authors.lastname: Sachdev
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cannon
authors.forename: Terry J
authors.initials: TJ
authors.lastname: Coyne
authors.forename: Peter
authors.initials: P
authors.lastname: Silburn
mesh_terms: D000328:Adult; D015897:Comorbidity; D046690:Deep Brain Stimulation / Q000379:methods*; D004292:Dominance, Cerebral / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D009714:Nucleus Accumbens / Q000503:physiopathology*; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D005879:Tourette Syndrome / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome