Deep Brain Stimulation for Obsessive-Compulsive Disorder: Is the Side Relevant?

作者：Barcia Juan A^*; Reyes Laura; Arza Rocio; Saceda Javier; Avecillas Josue; Yanez Rosa; Garcia Albea Julia; Ortiz Tomas; Lopez Ibor Maria Ines; Lopez Ibor Juan Jose

来源：Stereotactic and Functional Neurosurgery, 2014, 92(1): 31-36.

DOI：10.1159/000353187

• Psychiatric surgery
• Psychosurgery
• Deep brain stimulation
• Obsessive-compulsive disorder
• Nucleus accumbens stimulation
• Subthalamic nucleus stimulation
• Personalized target

Background: Deep brain stimulation for obsessive-compulsive disorder (OCD) has targeted several subcortical nuclei, including the subthalamic nucleus (STN) and the nucleus accunnbens. While the most appropriate target is still being looked for, little attention has been given to the side of the stimulated hemisphere in relationship to outcome. Methods: We report 2 patients diagnosed with OCD, one having symmetry obsessions and the other one with sexual-religious obsessive thoughts. They were implanted bilaterally with deep electrodes located at both STN and nuclei accumbens. The effectiveness of the stimulation was tested for every possible paired combination of electrodes guided by the Yale-Brown.Obsessive Compulsive Scale (Y-BOCS) score reduction. Results: In both cases, the combination of electrodes which best relieved the OCD symptoms was both the left STN and left accumbens. In case 1, the preoperative Y-BOCS score was 33, and 1 month after stimulation it was 16. In case 2, the Y-BOCS scores were 33 and 3, respectively, with the patient being free of obsessions. Conclusion: Some reports suggest that lesion stimulation or stimulation of only the right side relieves OCD symptoms. However, anatomical and functional studies are not conclusive as to which side is most affected in OCD. Possibly, each OCD patient has an individualized optimal side to stimulate.

• 出版日期2014