Deep brain stimulation increases impulsivity in two patients with obsessive-compulsive disorder.

Area of Science:

• Neurosurgery
• Psychiatry
• Neuroscience

Background:

• Deep brain stimulation (DBS) is an experimental neurosurgical treatment for refractory obsessive-compulsive disorder (OCD).
• The novelty of DBS for OCD necessitates close monitoring for potential side effects.
• Understanding the mechanisms of DBS, particularly its effects on brain circuitry, is ongoing.

Observation:

• This case report details two patients with treatment-refractory OCD undergoing DBS targeting the nucleus accumbens.
• An increase in DBS voltage led to immediate and significant increases in impulsivity, irritability, and self-confidence.
• These behavioral changes were reversible upon reduction of the stimulation voltage.

Findings:

• Elevated DBS voltage in the nucleus accumbens correlated with increased impulsivity in OCD patients.
• The observed effects suggest a potential impact on corticostriatal circuitry, which regulates impulsive behaviors.
• Stimulation parameters, including location and amplitude, may critically influence the induction of such behaviors.

Implications:

• These findings highlight the importance of vigilant clinical assessment for impulsive behaviors during DBS therapy for OCD.
• Further research is needed to elucidate the precise mechanisms linking nucleus accumbens stimulation to impulsivity.
• Optimizing DBS parameters is essential to maximize therapeutic benefits while minimizing adverse behavioral effects in OCD treatment.