• Neuromodulation · Feb 2021

    Optimizing Deep Brain Stimulation Parameters in Obsessive-Compulsive Disorder.

    • Maarten van Westen, Erik Rietveld, Isidoor O Bergfeld, Pelle de Koning, Nienke Vullink, Pieter Ooms, Ilse Graat, Luka Liebrand, Pepijn van den Munckhof, Rick Schuurman, and Damiaan Denys.
    • Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef, 9, Amsterdam, The Netherlands.
    • Neuromodulation. 2021 Feb 1; 24 (2): 307315307-315.

    ObjectivesDeep brain stimulation (DBS) is an innovative and effective treatment for patients with therapy-refractory obsessive-compulsive disorder (OCD). DBS offers unique opportunities for personalized care, but no guidelines on how to choose effective and safe stimulation parameters in patients with OCD are available. Our group gained relevant practical knowledge on DBS optimization by treating more than 80 OCD patients since 2005, the world's largest cohort. The article's objective is to share this experience.Materials And MethodsWe provide guiding principles for optimizing DBS stimulation parameters in OCD and discuss the neurobiological and clinical basis.ResultsAdjustments in stimulation parameters are performed in a fixed order. First, electrode contact activation is determined by the position of the electrodes on postoperative imaging. Second, voltage and pulse width are increased stepwise, enlarging both the chance of symptom reduction and of inducing side effects. Clinical evaluation of adjustments in stimulation parameters needs to take into account: 1) the particular temporal sequence in which the various OCD symptoms and DBS side-effects change; 2) the lack of robust response predictors; 3) the limited sensitivity of the Yale-Brown Obsessive-Compulsive Scale to assess DBS-induced changes in OCD symptoms; and 4) a patient's fitness for additional cognitive-behavioral therapy (CBT).ConclusionsDecision-making in stimulation parameter optimization needs to be sensitive to the particular time-courses on which various symptoms and side effects change.© 2020 The Authors. Neuromodulation: Technology at the Neural Interface published by Wiley Periodicals LLC. on behalf of International Neuromodulation Society.

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