Pilot study of deep brain stimulation in refractory obsessive–compulsive disorder ethnic Chinese patients

Authors


  • Portions of this work were presented in poster form at the CINP (The International College of Neuropsychopharmacology) World Congress, Hong Kong, 6–10 June 2010.

Shin-Yuan Chen, MD, MS, Department of Neurosurgery, Institute of Medical Science, Tzu-Chi University, Tzu-Chi General Hospital, no. 707, Sec. 3, Chung Yang Rd., Hualien 970, Taiwan. Email: chang763@gmail.com

Abstract

Aims:  Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) is a promising alternative to ablative surgery in treatment of refractory obsessive–compulsive disorder (OCD). A pilot study was conducted to assess 15-month outcomes of DBS in patients with refractory OCD in Taiwan.

Methods:  Four adult patients with a 3-year or more history of refractory OCD (Yale–Brown Obsessive–Compulsive Scale [Y-BOCS] score of at least 28) met the criteria for DBS surgery. DBS electrodes were implanted bilaterally in the VC/VS. Stimulation was adjusted for therapeutic benefit and absence of adverse effects. Psychiatric evaluation was conducted preoperatively, postoperatively, and at follow up at every 3 months for 15 months. Primary outcome measure was Y-BOCS. Secondary outcomes included the Hamilton Depression Rating Scale (HAM-D), and the Global Assessment of Function Scale.

Results:  Mean severity of OCD was a Y-BOCS score of 36.3 ± 2.1. At the end of 15 months' follow up, there was a 33.06% decrease in OCD severity (P = 0.001). Similar findings were seen for HAM-D (32.51% reduction, P = 0.005), and Global Assessment of Function Scale (31.03% increase, P = 0.026). In terms of adverse effects, two patients suffered from hypomania episodes after several weeks of DBS stimulation, and one had transient hypomania-like syndrome during DBS initial programming. One patient (Case 1) had an allergic reaction to implantation of the pulse generator in the chest, and another patient (Case 3) exhibited vertigo.

Conclusions:  We confirm that DBS of the VC/VS appears to be beneficial for improvements in function and mood among patients with treatment-resistant OCD. Compared to previous studies examining the therapeutic effects of DBS, no serious adverse effects were observed.

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