Open-label trial of anterior limb of internal capsule-nucleus accumbens deep brain stimulation for obsessive-compulsive disorder: insights gained.
Journal
Journal of neurology, neurosurgery, and psychiatry
ISSN: 1468-330X
Titre abrégé: J Neurol Neurosurg Psychiatry
Pays: England
ID NLM: 2985191R
Informations de publication
Date de publication:
07 2019
07 2019
Historique:
received:
12
06
2018
revised:
21
01
2019
accepted:
21
01
2019
pubmed:
17
2
2019
medline:
18
3
2020
entrez:
17
2
2019
Statut:
ppublish
Résumé
For more than 15 years, deep brain stimulation (DBS) has served as a last-resort treatment for severe treatment-resistant obsessive-compulsive disorder (OCD). 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 30770458
pii: jnnp-2018-318996
doi: 10.1136/jnnp-2018-318996
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
805-812Informations de copyright
© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
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.