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Deep brain stimulation for obsessive-compulsive disorder: is the side relevant?

Juan A Barcia1, Laura Reyes, Rocío Arza

  • 1Servicio de Neurocirugía, Instituto of Neurociencias, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.

Stereotactic and Functional Neurosurgery
|November 13, 2013
PubMed
Summary

Deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) may be more effective when targeting the left subthalamic nucleus (STN) and left nucleus accumbens. This case study suggests individualized hemispheric targeting for improved OCD symptom relief.

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Area of Science:

  • Neuroscience
  • Neurosurgery
  • Psychiatry

Background:

  • Deep brain stimulation (DBS) is an emerging treatment for obsessive-compulsive disorder (OCD).
  • Current DBS research for OCD has explored various subcortical targets, including the subthalamic nucleus (STN) and nucleus accumbens.
  • Limited investigation has focused on the impact of hemispheric laterality in DBS outcomes for OCD.

Observation:

  • This study presents two patients diagnosed with OCD, presenting with symmetry obsessions and sexual-religious obsessive thoughts, respectively.
  • Both patients underwent bilateral implantation of deep electrodes targeting the STN and nucleus accumbens.
  • Stimulation effectiveness was evaluated across all electrode combinations, using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for symptom severity assessment.

Findings:

  • In both cases, optimal symptom reduction was achieved by stimulating the left STN and left nucleus accumbens.
  • Patient 1 showed a decrease in Y-BOCS score from 33 to 16 post-stimulation.
  • Patient 2 experienced a significant reduction from 33 to 3, achieving remission from obsessive thoughts.

Implications:

  • Findings challenge previous suggestions of right-sided stimulation efficacy in OCD.
  • Results indicate that optimal hemispheric targeting in DBS for OCD may be patient-specific.
  • Further research into individualized laterality in DBS is warranted for optimizing OCD treatment outcomes.