Deep brain stimulation for treatment resistant obsessive compulsive disorder; an observational study with ten patients under real-life conditions
IntroductionObsessive-compulsive disorder (OCD) affects 2–3% of the global population, causing distress in many functioning levels. Standard treatments only lead to a partial recovery, and about 10% of the patients remain treatment-resistant. Deep brain stimulation offers a treatment option for seve...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-09-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1242566/full |
| _version_ | 1797687142952992768 |
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| author | Mohamed A. Abdelnaim Mohamed A. Abdelnaim Verena Lang-Hambauer Verena Lang-Hambauer Tobias Hebel Stefan Schoisswohl Stefan Schoisswohl Martin Schecklmann Daniel Deuter Daniel Deuter Juergen Schlaier Juergen Schlaier Berthold Langguth Berthold Langguth |
| author_facet | Mohamed A. Abdelnaim Mohamed A. Abdelnaim Verena Lang-Hambauer Verena Lang-Hambauer Tobias Hebel Stefan Schoisswohl Stefan Schoisswohl Martin Schecklmann Daniel Deuter Daniel Deuter Juergen Schlaier Juergen Schlaier Berthold Langguth Berthold Langguth |
| author_sort | Mohamed A. Abdelnaim |
| collection | DOAJ |
| description | IntroductionObsessive-compulsive disorder (OCD) affects 2–3% of the global population, causing distress in many functioning levels. Standard treatments only lead to a partial recovery, and about 10% of the patients remain treatment-resistant. Deep brain stimulation offers a treatment option for severe, therapy-refractory OCD, with a reported response of about 60%. We report a comprehensive clinical, demographic, and treatment data for patients who were treated with DBS in our institution.MethodsWe offered DBS to patients with severe chronic treatment resistant OCD. Severity was defined as marked impairment in functioning and treatment resistance was defined as non-response to adequate trials of medications and psychotherapy. Between 2020 and 2022, 11 patients were implanted bilaterally in the bed nucleus of stria terminalis (BNST). Patients were evaluated with YBOCS, MADRS, GAF, CGI, and WHOQOL-BREF. We performed the ratings at baseline (before surgery), after implantation before the start of the stimulation, after reaching satisfactory stimulation parameters, and at follow-up visits 3, 6, 9, and 12 months after optimized stimulation.ResultsOne patient has retracted his consent to publish the results of his treatment, thus we are reporting the results of 10 patients (5 males, 5 females, mean age: 37 years). Out of our 10 patients, 6 have shown a clear response indicated by a YBOCS-reduction between 42 and 100 percent at last follow-up. One further patient experienced a subjectively dramatic effect on OCD symptoms, but opted afterwards to stop the stimulation. The other 3 patients showed a slight, non-significant improvement of YBOCS between 8.8 and 21.9%. The overall mean YBOCS decreased from 28.3 at baseline to 13.3 (53% reduction) at the last follow-up. The improvement of the OCD symptoms was also accompanied by an improvement of depressive symptoms, global functioning, and quality of life.ConclusionOur results suggest that BNST-DBS can be effective for treatment-resistant OCD patients, as indicated by a reduction in symptoms and an overall improvement in functioning. Despite the need for additional research to define the patients’ selection criteria, the most appropriate anatomical target, and the most effective stimulation parameters, improved patient access for this therapy should be established. |
| first_indexed | 2024-03-12T01:15:02Z |
| format | Article |
| id | doaj.art-c319a1ee5cba43a79683d557d3069509 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-03-12T01:15:02Z |
| publishDate | 2023-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-c319a1ee5cba43a79683d557d30695092023-09-13T19:30:18ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402023-09-011410.3389/fpsyt.2023.12425661242566Deep brain stimulation for treatment resistant obsessive compulsive disorder; an observational study with ten patients under real-life conditionsMohamed A. Abdelnaim0Mohamed A. Abdelnaim1Verena Lang-Hambauer2Verena Lang-Hambauer3Tobias Hebel4Stefan Schoisswohl5Stefan Schoisswohl6Martin Schecklmann7Daniel Deuter8Daniel Deuter9Juergen Schlaier10Juergen Schlaier11Berthold Langguth12Berthold Langguth13Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, GermanyCenter for Deep Brain Stimulation, University Regensburg, Regensburg, GermanyDepartment of Psychiatry and Psychotherapy, University Regensburg, Regensburg, GermanyCenter for Deep Brain Stimulation, University Regensburg, Regensburg, GermanyDepartment of Psychiatry and Psychotherapy, University Regensburg, Regensburg, GermanyDepartment of Psychiatry and Psychotherapy, University Regensburg, Regensburg, GermanyDepartment of Psychology, University of the Bundeswehr Munich, Neubiberg, GermanyDepartment of Psychiatry and Psychotherapy, University Regensburg, Regensburg, GermanyCenter for Deep Brain Stimulation, University Regensburg, Regensburg, GermanyDepartment of Neurosurgery, University Regensburg, Regensburg, GermanyCenter for Deep Brain Stimulation, University Regensburg, Regensburg, GermanyDepartment of Neurosurgery, University Regensburg, Regensburg, GermanyDepartment of Psychiatry and Psychotherapy, University Regensburg, Regensburg, GermanyCenter for Deep Brain Stimulation, University Regensburg, Regensburg, GermanyIntroductionObsessive-compulsive disorder (OCD) affects 2–3% of the global population, causing distress in many functioning levels. Standard treatments only lead to a partial recovery, and about 10% of the patients remain treatment-resistant. Deep brain stimulation offers a treatment option for severe, therapy-refractory OCD, with a reported response of about 60%. We report a comprehensive clinical, demographic, and treatment data for patients who were treated with DBS in our institution.MethodsWe offered DBS to patients with severe chronic treatment resistant OCD. Severity was defined as marked impairment in functioning and treatment resistance was defined as non-response to adequate trials of medications and psychotherapy. Between 2020 and 2022, 11 patients were implanted bilaterally in the bed nucleus of stria terminalis (BNST). Patients were evaluated with YBOCS, MADRS, GAF, CGI, and WHOQOL-BREF. We performed the ratings at baseline (before surgery), after implantation before the start of the stimulation, after reaching satisfactory stimulation parameters, and at follow-up visits 3, 6, 9, and 12 months after optimized stimulation.ResultsOne patient has retracted his consent to publish the results of his treatment, thus we are reporting the results of 10 patients (5 males, 5 females, mean age: 37 years). Out of our 10 patients, 6 have shown a clear response indicated by a YBOCS-reduction between 42 and 100 percent at last follow-up. One further patient experienced a subjectively dramatic effect on OCD symptoms, but opted afterwards to stop the stimulation. The other 3 patients showed a slight, non-significant improvement of YBOCS between 8.8 and 21.9%. The overall mean YBOCS decreased from 28.3 at baseline to 13.3 (53% reduction) at the last follow-up. The improvement of the OCD symptoms was also accompanied by an improvement of depressive symptoms, global functioning, and quality of life.ConclusionOur results suggest that BNST-DBS can be effective for treatment-resistant OCD patients, as indicated by a reduction in symptoms and an overall improvement in functioning. Despite the need for additional research to define the patients’ selection criteria, the most appropriate anatomical target, and the most effective stimulation parameters, improved patient access for this therapy should be established.https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1242566/fullOCDDBSBNSTinvasive brain stimulationtreatment-resistant obsessive-compulsive disorder |
| spellingShingle | Mohamed A. Abdelnaim Mohamed A. Abdelnaim Verena Lang-Hambauer Verena Lang-Hambauer Tobias Hebel Stefan Schoisswohl Stefan Schoisswohl Martin Schecklmann Daniel Deuter Daniel Deuter Juergen Schlaier Juergen Schlaier Berthold Langguth Berthold Langguth Deep brain stimulation for treatment resistant obsessive compulsive disorder; an observational study with ten patients under real-life conditions Frontiers in Psychiatry OCD DBS BNST invasive brain stimulation treatment-resistant obsessive-compulsive disorder |
| title | Deep brain stimulation for treatment resistant obsessive compulsive disorder; an observational study with ten patients under real-life conditions |
| title_full | Deep brain stimulation for treatment resistant obsessive compulsive disorder; an observational study with ten patients under real-life conditions |
| title_fullStr | Deep brain stimulation for treatment resistant obsessive compulsive disorder; an observational study with ten patients under real-life conditions |
| title_full_unstemmed | Deep brain stimulation for treatment resistant obsessive compulsive disorder; an observational study with ten patients under real-life conditions |
| title_short | Deep brain stimulation for treatment resistant obsessive compulsive disorder; an observational study with ten patients under real-life conditions |
| title_sort | deep brain stimulation for treatment resistant obsessive compulsive disorder an observational study with ten patients under real life conditions |
| topic | OCD DBS BNST invasive brain stimulation treatment-resistant obsessive-compulsive disorder |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1242566/full |
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