The medial forebrain bundle as a target for deep brain stimulation for obsessive-compulsive disorder

Area of Science:

• Neurosurgery
• Psychiatry
• Neuroscience

Background:

• Deep brain stimulation (DBS) is explored for refractory psychiatric disorders like major depression and obsessive-compulsive disorder (OCD).
• The supero-lateral branch of the medial forebrain bundle (slMFB) is a potential target, particularly for major depression.
• The potential role of the reward system in OCD suggests slMFB DBS as a relevant therapeutic strategy.

Observation:

• This study presents the first two cases of bilateral DBS targeting the slMFB for OCD.
• Diffusion tensor imaging (DTI) fiber tractography (FT) guided the surgical implantation of DBS electrodes.
• Patients were followed for 12 months post-implantation.

Findings:

• One patient experienced a 35% reduction in Yale-Brown Obsessive-Compulsive Scale (YBOCS) scores.
• The second patient achieved remission criteria (YBOCS < 14) within 3 months, maintaining mild OCD symptoms at 12 months.
• Continuous bilateral slMFB DBS resulted in clinically significant improvements in OCD severity ratings.

Implications:

• Findings suggest the reward system plays a crucial role in OCD pathophysiology and recovery.
• This approach may offer a novel treatment avenue for patients with severe OCD.
• Further research is warranted to elucidate the neurobiological mechanisms underlying slMFB DBS efficacy in OCD.