title: Deep brain stimulation of the nucleus accumbens and bed nucleus of stria terminalis for obsessive-compulsive disorder: a case series.
abstract: BACKGROUND
  Obsessive-compulsive disorder (OCD) is a psychiatric condition defined by the presence of obsessions, compulsions, or both. It has a lifetime prevalence of 2%-3% and causes significant impairment in social and work functioning, as well as a reduced quality of life. Treatment includes pharmacotherapy and psychotherapy, but a significant number of patients fail to respond to treatment. Deep brain stimulation has shown to be a safe and effective procedure for severe, chronic, treatment-resistant OCD, and several surgical targets have been proposed for treatment, including the nucleus accumbens, the anterior limb of the internal capsule, the subthalamic nucleus, the globus pallidus, and the bed nucleus of stria terminalis.
  
  
  OBJECTIVE
  To report the first Italian case series of patients who underwent DBS of 2 distinct targets for OCD: nulceus accumbens and bed nulceus of stria terminalis.
  
  
  METHODS
  Four patients underwent DBS of the nulceus accumbens, and 4 patients underwent DBS of the bed nucleus of stria terminalis.
  
  
  RESULTS
  Six patients showed a significant improvement in OCD symptoms.
  
  
  CONCLUSIONS
  DBS of these 2 structures is a safe and effective procedure for the treatment of severe, refractory OCD.
authors.affiliation: Department of Psychiatry, University of Milan Medical School, Ospedale San Paolo, Milan, Italy. Electronic address: lucrezia.islam@unimi.it.
authors.forename: Lucrezia
authors.initials: L
authors.lastname: Islam
authors.affiliation: Department of Neurosurgery, Istituto Neurologico Carlo Besta, Milan, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Franzini
authors.affiliation: Department of Neurosurgery, Istituto Neurologico Carlo Besta, Milan, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Messina
authors.affiliation: Department of Psychiatry, University of Milan Medical School, Ospedale San Paolo, Milan, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Scarone
authors.affiliation: Department of Psychiatry, University of Milan Medical School, Ospedale San Paolo, Milan, Italy.
authors.forename: Orsola
authors.initials: O
authors.lastname: Gambini
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009714:Nucleus Accumbens; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012686:Septal Nuclei; D016896:Treatment Outcome
keywords: Bed nucleus stria terminalis; Deep brain stimulation; Nucleus accumbens; Obsessive-compulsive disorder