title: Anterior Cingulate Implant for Obsessive-Compulsive Disorder.
abstract: BACKGROUND
  Obsessive-compulsive disorder (OCD) is a brain disorder with a lifetime prevalence of 2.3%, causing severe functional impairment as a result of anxiety and distress, persistent and repetitive, unwanted, intrusive thoughts (obsessions), and repetitive ritualized behavior (compulsions). Approximately 40%-60% of patients with OCD fail to satisfactorily respond to standard treatments. Intractable OCD has been treated by anterior capsulotomy and cingulotomy, but more recently, neurostimulation approaches have become more popular because of their reversibility.
  
  
  OBJECTIVE
  Implants for OCD are commonly being used, targeting the anterior limb of the internal capsula or the nucleus accumbens, but an implant on the anterior cingulate cortex has never been reported.
  
  
  METHODS
  We describe a patient who was primarily treated for alcohol addiction, first with transcranial magnetic stimulation, then by implantation of 2 electrodes overlying the rostrodorsal part of the anterior cingulate cortex bilaterally.
  
  
  RESULTS
  Her alcohol addiction developed as she was relief drinking to self-treat her OCD, anxiety, and depression. After the surgical implant, she underwent placebo stimulation followed by real stimulation of the dorsal anterior cingulate cortex, which dramatically improved her OCD symptoms (decrease of 65.5% on the Yale-Brown Obsessive Compulsive Drinking Scale) as well as her alcohol craving (decrease of 87.5%) after 36 weeks of treatment. Although there were improvements in all the scores, there was only a modest reduction in the patient's weekly alcohol consumption (from 50 units to 32 units).
  
  
  CONCLUSIONS
  Based on these preliminary positive results we propose to further study the possible beneficial effect of anterior cingulate cortex stimulation for intractable OCD.
authors.affiliation: Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand. Electronic address: sven.vanneste@utdallas.edu.
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ridder
authors.affiliation: Section of Endocrinology, Department of Internal Medicine, Dunedin School of Medicine, University of Otago, New Zealand.
authors.forename: Sook Ling
authors.initials: SL
authors.lastname: Leong
authors.affiliation: Section of Endocrinology, Department of Internal Medicine, Dunedin School of Medicine, University of Otago, New Zealand.
authors.forename: Patrick
authors.initials: P
authors.lastname: Manning
authors.affiliation: Laboratory for Clinical & Integrative Neuroscience, School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, Texas, USA.
authors.forename: Sven
authors.initials: S
authors.lastname: Vanneste
authors.affiliation: Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand.
authors.forename: Paul
authors.initials: P
authors.lastname: Glue
mesh_terms: D000437:Alcoholism / Q000175:diagnosis / Q000517:prevention & control*; D046690:Deep Brain Stimulation / Q000295:instrumentation* / Q000379:methods; D004567:Electrodes, Implanted; D005260:Female; D006179:Gyrus Cinguli / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000517:prevention & control*; D016896:Treatment Outcome
keywords: Addiction; Alcohol; Cingulate; Obsessive-compulsive disorder; Y-BOCS