Deep brain stimulation for obsessive-compulsive disorder: is the side relevant?
BACKGROUND
Deep brain stimulation for obsessive-compulsive disorder (OCD) has targeted several subcortical nuclei, including the subthalamic nucleus (STN) and the nucleus accumbens. While the most appropriate target is still being looked for, little attention has been given to the side of the stimulated hemisphere in relationship to outcome.


METHODS
We report 2 patients diagnosed with OCD, one having symmetry obsessions and the other one with sexual-religious obsessive thoughts. They were implanted bilaterally with deep electrodes located at both STN and nuclei accumbens. The effectiveness of the stimulation was tested for every possible paired combination of electrodes guided by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score reduction.


RESULTS
In both cases, the combination of electrodes which best relieved the OCD symptoms was both the left STN and left accumbens. In case 1, the preoperative Y-BOCS score was 33, and 1 month after stimulation it was 16. In case 2, the Y-BOCS scores were 33 and 3, respectively, with the patient being free of obsessions.


CONCLUSIONS
Some reports suggest that lesion stimulation or stimulation of only the right side relieves OCD symptoms. However, anatomical and functional studies are not conclusive as to which side is most affected in OCD. Possibly, each OCD patient has an individualized optimal side to stimulate.
Servicio de Neurocirugía, Instituto of Neurociencias, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
Juan A
JA
Barcia
Laura
L
Reyes
Rocío
R
Arza
Javier
J
Saceda
Josué
J
Avecillas
Rosa
R
Yáñez
Julia
J
García-Albea
Tomás
T
Ortiz
Maria-Inés
MI
López-Ibor
Juan-José
JJ
López-Ibor
D000328:Adult; D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009714:Nucleus Accumbens / Q000473:pathology / Q000503:physiopathology*; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology / Q000628:therapy*; D015203:Reproducibility of Results; D020531:Subthalamic Nucleus / Q000473:pathology / Q000503:physiopathology*; D016896:Treatment Outcome