title: Clinical Outcome and Mechanisms of Deep Brain Stimulation for Obsessive-Compulsive Disorder.
abstract: Clinical outcome of deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) shows robust effects in terms of a mean Yale-Brown Obsessive-Compulsive Scale (YBOCS) reduction of 47.7 % and a mean response percentage (minimum 35 % YBOCS reduction) of 58.2 %. It appears that most patients regain a normal quality of life (QoL) after DBS. Reviewing the literature of the last 4 years, we argue that the mechanisms of action of DBS are a combination of excitatory and inhibitory as well as local and distal effects. Evidence from DBS animal models converges with human DBS EEG and imaging findings, in that DBS may be effective for OCD by reduction of hyperconnectivity between frontal and striatal areas. This is achieved through reduction of top-down-directed synchrony and reduction of frontal low-frequency oscillations. DBS appears to counteract striatal dysfunction through an increase in striatal dopamine and through improvement of reward processing. DBS affects anxiety levels through reduction of stress hormones and improvement of fear extinction.
authors: Department of Psychiatry, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
authors: Maarten
authors: M
authors: van Westen
authors: Department of Psychiatry, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ; Amsterdam Brain and Cognition Center, University of Amsterdam, Nieuwe Achtergracht 129 (Building L), 1018 WS Amsterdam, The Netherlands ; Department of Philosophy, Institute for Logic, Language and Computation, University of Amsterdam, Science Park 107, 1098 XG Amsterdam, The Netherlands.
authors: Erik
authors: E
authors: Rietveld
authors: Department of Psychiatry, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ; Amsterdam Brain and Cognition Center, University of Amsterdam, Nieuwe Achtergracht 129 (Building L), 1018 WS Amsterdam, The Netherlands.
authors: Martijn
authors: M
authors: Figee
authors: Department of Psychiatry, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ; Amsterdam Brain and Cognition Center, University of Amsterdam, Nieuwe Achtergracht 129 (Building L), 1018 WS Amsterdam, The Netherlands ; The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands.
authors: Damiaan
authors: D
authors: Denys
keywords: Clinical outcome; Deep brain stimulation; Mechanisms of action; Obsessive-compulsive disorder; Quality of life