title: Removing and reimplanting deep brain stimulation therapy devices in resistant OCD (when the patient does not respond): case report.
abstract: BACKGROUND
  Deep brain stimulation (DBS) is emerging as a promising tool in the treatment of refractory obsessive-compulsive disorder (OCD) but the search for the best target still continues. This issue is especially relevant when particularly resistant profiles are observed in some patients, which have been ascribed to individual responses to DBS according to differential patterns of connectivity. As patients have been implanted, new dilemmas have emerged, such as what to do when the patient does not respond to surgery.
  
  
  METHODS
  Here we describe a 22-year-old male with extremely severe OCD who did not respond to treatment with DBS in the nucleus accumbens, but who did respond after explanting and reimplanting leads targeting the ventral capsule-ventral striatum region. Information regarding the position of the electrodes for both surgeries is provided and possible brain structures affected during stimulation are reviewed. To our knowledge this case is the first in the literature reporting the removal and reimplantation of DBS leads for therapeutical benefits in a patient affected by a mental disorder.
  
  
  CONCLUSIONS
  The capability for explantation and reimplantation of leads should be considered as part of the DBS therapy reversibility profile in resistant mental disorders, as it allows application in cases of non-response to the first surgery.
authors: Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), C/ Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Barcelona, Spain. ereal@bellvitgehospital.cat.|Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. ereal@bellvitgehospital.cat.
authors: Eva
authors: E
authors: Real
authors: Department of Neurosurgery, Bellvitge University Hospital, C/ Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Barcelona, Spain. gplans@bellvitgehospital.cat.
authors: Gerard
authors: G
authors: Plans
authors: Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), C/ Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Barcelona, Spain. mpalonso@bellvitgehospital.cat.|Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. mpalonso@bellvitgehospital.cat.|Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain. mpalonso@bellvitgehospital.cat.
authors: Pino
authors: P
authors: Alonso
authors: Department of Neurosurgery, Bellvitge University Hospital, C/ Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Barcelona, Spain. maparicio@bellvitgehospital.cat.
authors: Marco A
authors: MA
authors: Aparicio
authors: Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), C/ Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Barcelona, Spain. csegalas@bellvitgehospital.cat.|Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. csegalas@bellvitgehospital.cat.
authors: Cinto
authors: C
authors: Segalàs
authors: Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), C/ Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Barcelona, Spain. ncardoner@gmail.com.|Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. ncardoner@gmail.com.|Mental Health Department, Corporació Sanitària Parc Taulí, Sabadell, Spain. ncardoner@gmail.com.
authors: Narcís
authors: N
authors: Cardoner
authors: Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), C/ Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Barcelona, Spain. carles.soriano.mas@gmail.com.|Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. carles.soriano.mas@gmail.com.
authors: Carles
authors: C
authors: Soriano-Mas
authors: Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), C/ Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Barcelona, Spain. luna.clara20@gmail.com.|Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. luna.clara20@gmail.com.
authors: Clara
authors: C
authors: López-Solà
authors: Psychiatry Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), C/ Feixa Llarga s/n, 08907 Hospitalet del Llobregat, Barcelona, Spain. jmenchon@bellvitgehospital.cat.|Carlos III Health Institute, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain. jmenchon@bellvitgehospital.cat.|Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain. jmenchon@bellvitgehospital.cat.
authors: José M
authors: JM
authors: Menchón
mesh_terms: D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D020878:Device Removal / Q000379:methods; D004567:Electrodes, Implanted; D006801:Humans; D008297:Male; D009714:Nucleus Accumbens / Q000601:surgery*; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000601:surgery; D011569:Psychiatric Status Rating Scales; D012086:Reoperation / Q000379:methods*; D013238:Stereotaxic Techniques; D016896:Treatment Outcome; D066328:Ventral Striatum / Q000601:surgery*; D055815:Young Adult