Deep brain stimulation in obsessive-compulsive disorder - case report of two patients

Obsessive-compulsive disorder (OCD) occurs in 2-3% of the general population. Due to its chronicity and high resistance to standard treatment, alternative clinical management based on neuroscientific findings has been sought. Deep brain stimulation (DBS) is a modern and dynamic approach in the treatment of OCD giving hope to patients who are resistant to current pharmacotherapy and psychotherapy based treatments. This paper presents two cases of patients diagnosed with refractory OCD who received DBS therapy with concurrent pharmacotherapy and cognitive behavioral psychotherapy (CBT). Both patients underwent a neurosurgical procedure to implant electrodes into the anterior limb of the internal capsule (ALIC) and nucleus accumbens (NAc). Before and after the start of neurostimulation, patients underwent a clinical evaluation which consisted of a psychiatric examination and psychometric measurements (Y-BOCS, HAMA, HDRS, GAF, SOFAS). During the follow-up period, a blind attempt to switch off the neurostimulation was made. During the 6-month follow-up period, a significant reduction in the obsessive-compulsive, depressive and anxiety symptoms was achieved as well as an improvement in global patient functioning. The tolerance of DBS was found to be very good and no significant side effects were observed. The obtained results provide the basis for the implementation of this method in patients with OCD who are resistant to current treatment.