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Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by recurrent obsessions, compulsions, or both, which consume significant time and interfere with daily functioning. Obsessions involve persistent, intrusive, and unwanted thoughts, images, or urges that evoke anxiety. Common examples include irrational fears of contamination or harm. Compulsions are repetitive behaviors or mental acts performed to reduce the anxiety caused by obsessions. For instance, individuals...

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Optimizing Deep Brain Stimulation Parameters in Obsessive-Compulsive Disorder.

Maarten van Westen¹, Erik Rietveld¹, Isidoor O Bergfeld¹

¹Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef, 9, Amsterdam, The Netherlands.

Neuromodulation : Journal of the International Neuromodulation Society

|October 31, 2020

Summary

This summary is machine-generated.

Deep brain stimulation (DBS) offers personalized treatment for obsessive-compulsive disorder (OCD). This study shares experience on optimizing DBS parameters, guiding safe and effective symptom management for OCD patients.

Keywords:

Deep brain stimulation neuromodulation obsessive-compulsive disorder optimization stimulation parameters

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Area of Science:

Neuroscience
Neurosurgery
Psychiatry

Background:

Deep brain stimulation (DBS) is an effective treatment for therapy-refractory obsessive-compulsive disorder (OCD).
Personalized care is crucial, yet guidelines for optimizing DBS parameters in OCD are lacking.
The authors present experience from treating over 80 OCD patients, the world's largest cohort.

Purpose of the Study:

To provide guiding principles for optimizing DBS stimulation parameters in OCD.
To discuss the neurobiological and clinical basis for parameter optimization.
To share practical knowledge gained from extensive clinical experience.

Main Methods:

Systematic adjustments of stimulation parameters in a fixed order.
Determination of electrode contact activation based on postoperative imaging.
Stepwise increase of voltage and pulse width, monitoring for symptom reduction and side effects.

Main Results:

Clinical evaluation requires consideration of temporal symptom and side-effect changes.
Lack of robust predictors for DBS response in OCD.
Limited sensitivity of the Yale-Brown Obsessive-Compulsive Scale for assessing DBS-induced changes.
Patient's suitability for adjunctive cognitive-behavioral therapy (CBT) is a factor.

Conclusions:

Optimizing DBS stimulation parameters requires sensitivity to the dynamic time-courses of symptom and side-effect changes.
Personalized adjustments are key for effective and safe DBS therapy in OCD.