Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, staggered-onset...

Area of Science:

• Neurosurgery
• Psychiatry
• Neuromodulation

Background:

• Deep brain stimulation (DBS) has shown prior promise for severe obsessive compulsive disorder (OCD) cases unresponsive to conventional treatments.
• The anterior limb of the internal capsule is a previously targeted area for DBS in refractory OCD.

Purpose of the Study:

• To evaluate the safety and efficacy of DBS targeting the ventral capsule/ventral striatum (VC/VS) region in patients with severe, treatment-refractory OCD.
• To assess symptom improvement and functional outcomes in OCD patients undergoing DBS in the VC/VS.

Main Methods:

• A pilot study involving six adult patients with severe (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] ≥ 28) and treatment-refractory OCD.
• Bilateral DBS electrode arrays were implanted in the VC/VS region.
• A randomized, staggered-onset design was used, with stimulation initiated at 30 or 60 days post-surgery under blinded conditions.

Main Results:

• After 12 months, 66.7% (4/6) of patients met responder criteria (≥35% Y-BOCS improvement, endpoint Y-BOCS ≤ 16).
• No improvement was observed during sham stimulation periods.
• Significant improvement in depressive symptoms was noted across the group, and global functioning improved in responders. Adverse events were generally mild and manageable.

Conclusions:

• DBS of the VC/VS region appears to be a promising last-resort therapy for carefully selected patients with severe, intractable OCD.
• Further research is warranted to optimize subject selection, lead placement, DBS programming, and understand the underlying therapeutic mechanisms.