title: Combined bilateral anterior cingulotomy and ventral capsule/ventral striatum deep brain stimulation for refractory obsessive-compulsive disorder with major depression: do combined procedures have a long-term benefit?
abstract: BACKGROUND
  The ventral capsule (VC), ventral striatum (VS), and the anterior cingulate gyrus are parts of the obsessive-compulsive disorder (OCD) and depression circuits. We assessed whether a combination of bilateral anterior cingulotomy and VC/VS deep brain stimulation (DBS) had an additive effect in patients with OCD and major depression.
  
  
  METHODS
  Three patients with refractory OCD underwent combined bilateral anterior cingulotomy and VC/VS DBS procedures. All patients met the inclusion criteria for the Korean guidelines of DBS for OCD. Baseline Yale-Brown Obsessive-Compulsive Disorder Scale (Y-BOCS) scores, Hamilton Depression Rating Scale scores, and global assessments of functioning were evaluated. These scores were also serially estimated for more than 24 months after surgery at 3-month intervals.
  
  
  RESULTS
  The mean value of the baseline Y-BOCS scores was 34.7 (range 30-38); the mean Y-BOCS value decreased significantly to 23.0 (range 20-25) 3 months after the surgery. This score was maintained 2 years after surgery with a mean value of 19.0 (range 18-20).
  
  
  CONCLUSIONS
  The combination of the two therapies did not yield superior outcomes, as the clinical outcomes were comparable to those of previous reports for VC/VS DBS alone. Wide-area VC/VS DBS may be sufficient to control refractory OCD.
authors: Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors: Won Seok
authors: WS
authors: Chang
authors: Daeyoung
authors: D
authors: Roh
authors: Chan-Hyung
authors: CH
authors: Kim
authors: Jin Woo
authors: JW
authors: Chang
mesh_terms: D000328:Adult; D001479:Basal Ganglia / Q000502:physiology*; D003131:Combined Modality Therapy; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D003865:Major Depressive Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006179:Gyrus Cinguli / Q000502:physiology*; D006801:Humans; D008297:Male; D009434:Neural Pathways / Q000502:physiology; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D013238:Stereotaxic Techniques; D013788:Thalamus / Q000502:physiology; D016896:Treatment Outcome
keywords: Brain stimulation; depression; obsessive-compulsive disorder; treatment resistant