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Deep brain stimulation programming for intractable obsessive-compulsive disorder using a long pulse width.

Emily Beydler1, Lauren Katzell1, Kevin Putinta2

  • 1College of Medicine, University of Florida, Gainesville, FL, United States.

Frontiers in Psychiatry
|July 17, 2023
PubMed
Summary
This summary is machine-generated.

Deep Brain Stimulation (DBS) offers hope for treatment-refractory obsessive-compulsive disorder (OCD). A novel programming approach successfully improved symptoms in a patient with severe OCD, demonstrating a potential new treatment pathway.

Keywords:
anterior limb of the internal capsulecase reportscase reports deep brain stimulationdeep brain stimulationintractable OCDmonopolar settingspsychiatric deep brain stimulation

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Area of Science:

  • Neurosurgery
  • Psychiatry
  • Neuromodulation

Background:

  • Approximately 25% of patients with obsessive-compulsive disorder (OCD) exhibit resistance to standard treatments, necessitating alternative therapeutic strategies.
  • Deep Brain Stimulation (DBS) is an emerging, safe, and effective option for individuals with treatment-refractory OCD.
  • Current post-operative programming algorithms for psychiatrists are lacking, despite the potential of intraoperative device interrogation.

Observation:

  • A 58-year-old female with severe, intractable OCD, unresponsive to multiple treatments, underwent bilateral DBS targeting the anterior limb of the internal capsule/nucleus accumbens (ALIC/NAc).
  • Intraoperative interrogation provided limited guidance for programming.
  • Systematic outpatient programming using various stimulation parameters yielded no observable effects.

Findings:

  • A novel programming strategy, creating an electrical field via triple monopoles using ventral contacts in the ALIC bilaterally, was implemented.
  • This approach resulted in significant improvement in the patient's OCD symptoms, particularly checking behaviors, sustained over several months.
  • The majority of DBS lead contacts do not elicit clear physiological markers, complicating programming optimization.

Implications:

  • This case highlights a successful, albeit unconventional, approach to DBS programming for treatment-refractory OCD when standard methods fail.
  • Further research into optimizing DBS programming algorithms and understanding the mechanisms of physiological markers is warranted.
  • This strategy may offer a viable alternative for patients with severe OCD who have not responded to conventional therapies.