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  • Open-label trial of anterior limb of internal capsule–nucleus accumbens deep brain stimulation for obsessive-compulsive disorder: insights gained

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Neuropsychiatry
Research paper
Open-label trial of anterior limb of internal capsule–nucleus accumbens deep brain stimulation for obsessive-compulsive disorder: insights gained
  1. Daniel Huys1,
  2. Sina Kohl1,
  3. Juan Carlos Baldermann1,
  4. Lars Timmermann2,
  5. Volker Sturm3,
  6. Veerle Visser-Vandewalle1,4,
  7. Jens Kuhn1,5
  1. 1 Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Cologne, Germany
  2. 2 Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
  3. 3 Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
  4. 4 Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
  5. 5 Johanniter Hospital Oberhausen, Department of Psychiatry, Psychotherapy and Psychosomatics, Oberhausen, Germany
  1. Correspondence to Dr. med. Daniel Huys, Klinik und Poliklinik fur Psychiatrie und Psychotherapie, Uniklinik Köln, 50937 Köln, Germany; daniel.huys{at}uk-koeln.de

Abstract

Background For more than 15 years, deep brain stimulation (DBS) has served as a last-resort treatment for severe treatment-resistant obsessive-compulsive disorder (OCD).

Methods From 2010 to 2016, 20 patients with OCD (10 men/10 women) were included in a single-centre trial with a naturalistic open-label design over 1 year to evaluate the effects of DBS in the anterior limb of the internal capsule and nucleus accumbens region (ALIC-NAcc) on OCD symptoms, executive functions, and personality traits.

Results ALIC-NAcc-DBS significantly decreased OCD symptoms (mean Yale-Brown Obsessive Compulsive Scale reduction 33%, 40% full responders) and improves global functioning without loss of efficacy over 1 year. No significant changes were found in depressive or anxiety symptoms. Our study did not show any effect of ALIC-NAcc-DBS on personality traits or executive functions, and no potential outcome predictors were identified in a post hoc analysis. Other than several individual minor adverse events, ALIC-NAcc-DBS has been shown to be safe, but 35% of patients reported a sudden increase in anxiety and anhedonia after acute cessation of stimulation.

Conclusions We conclude that ALIC-NAcc-DBS is a well-tolerated and promising last-resort treatment option for OCD. The cause of variability in the outcome remains unclear, and the aspect of reversibility must be examined critically. The present data from one of the largest samples of patients with OCD treated with DBS thus far support the results of previous studies with smaller samples.

https://doi.org/10.1136/jnnp-2018-318996

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    Footnotes

    • DH, SK, VV-V and JK contributed equally.

    • Contributors JK and DH designed the study. DH, SK, JCB and JK did the clinical examinations. VS and VV-V performed the implantations of the electrodes. SK and JCB analysed the data. JCB designed the figures. DH and SK contributed equally to this paper and wrote the manuscript in consultation with JK, JCB and VV-V. JK and LT supervised the project. All authors provided critical feedback and helped shape the research, analysis and manuscript.

    • Disclaimer The funding sources supported the study financially and had no influence on study design, collection, analysis and interpretation of data, writing of report and in the decision to submit the paper for publication.

    • Competing interests The authors report no biomedical financial interests or potential conflicts of interest. LT received payments as a consultant for Medtronic Inc, Boston Scientific, SAPIENS, St. Jude Medical, GE Medical, Bayer Healthcare, UCB Schwarz Pharma, Archimedes Pharma. LT received honoraria as a speaker on symposia sponsored by Zambon Pharma, TEVA Pharma, Lundbeck Pharma, Bracco, Gianni PR, Medas Pharma, UCB Schwarz Pharma, Desitin Pharma, Boehringer Ingelheim, GlaxoSmithKline, Eumecom, Orion Pharma, Medtronic, Boston Scientific, Cephalon, Abott, GE Medical, Archimedes, Bayer, ProsStrakan Pharma. The institution of LT, not LT personally, received funding by the German Research Foundation, the German Ministry of Education and Research, Manfred und Ursula Müller Stiftung, Klüh Stiftung, Hoffnungsbaum e.V., NBIA Disorders Society USA, Köln Fortune, Medtronic, Deutsche Parkinson Vereinigung, Archimedes Pharma, Abott, Bayer, UCB, Zur Rose Pharma, TEVA. Neither LT nor any member of his family holds stocks, stock options, patents or financial interests in any of the abovementioned companies or their competitors. VV-V has received payments for travelling, lodging and financial compensation for contributions to advisory boards or workshops (mostly 2/year) by Medtronic, Abbott and St. Jude Medical. JK has received financial support for Investigator initiated trials from Medtronic GmbH and grants from the German Research Foundation and the Marga and Walter Boll Foundation.

    • Patient consent for publication Obtained.

    • Ethics approval The study was approved by the Ethics Committee of the University of Cologne and registered in the German Clinical Trials Register (www.drks.de, DRKS00005316).

    • Provenance and peer review Not commissioned; externally peer reviewed.