Cyclic versus continuous deep brain stimulation in patients with obsessive compulsive disorder: A randomized...

Area of Science:

• Neurosurgery
• Psychiatry
• Neuromodulation

Background:

• Deep brain stimulation (DBS) targeting the ventral anterior limb of the internal capsule (vALIC) is a recognized treatment for refractory obsessive-compulsive disorder (OCD).
• Standard DBS protocols for OCD often necessitate high stimulation voltages, increasing the risk of adverse events (AEs).

Purpose of the Study:

• To investigate the efficacy and safety of a cyclic stimulation protocol for DBS in OCD patients.
• The study aimed to optimize energy efficiency and minimize AEs associated with vALIC DBS for OCD.

Main Methods:

• A double-blind, randomized crossover trial was conducted involving 16 OCD patients.
• Participants received either continuous or cyclic (0.1s ON, 0.2s OFF) DBS for two weeks each, with outcomes assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), AEs, cognitive function, and quality of life.

Main Results:

• Cyclic DBS led to a significant increase in average Y-BOCS scores (5.5 points, p=0.006) and a trend towards increased HAM-D (2.2 points, p=0.088) and HAM-A (2.8 points, p=0.018) scores.
• While overall quality of life worsened (p=0.044), specific stimulation-related AEs like headaches and concentration problems decreased during cyclic DBS.
• Battery consumption was significantly lower with cyclic DBS (0.008 V/hr) compared to continuous DBS (0.021 V/hr).

Conclusions:

• Cyclic stimulation, despite reducing battery usage and some specific AEs, is associated with a high risk of symptom relapse in OCD patients.
• Cyclic DBS is not a substitute for standard continuous DBS treatment for OCD.
• This cyclic approach may be a viable option for managing debilitating AEs in specific patient cases.