• World Neurosurg · Nov 2021

    Multicenter Study

    Deep brain stimulation of the nucleus accumbens, ventral striatum or internal capsule targets for medication resistant obsessive compulsive disorder: a multicentric study.

    • Cristina V Torres Díaz, Svenja Treu, Bryan Strange, Monica Lara, Marta Navas, Elena Ezquiaga, Elisa Seijo Zazo, Juncal Sevilla Vicente, Isabel Muñiz, and Fernando Seijo Fernandez.
    • Department of Neurourgery, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain. Electronic address: cristinatorresdiaz@yahoo.es.
    • World Neurosurg. 2021 Nov 1; 155: e168-e176.

    BackgroundDeep brain stimulation of the nucleus accumbens, ventral striatum, or internal capsule region has shown a 45%-60% response rate in adults with severe treatment-refractory obsessive-compulsive disorder, regardless of which target is used. We sought to improve the effectiveness of deep brain stimulation by placing the electrode along a trajectory including these 3 targets, enabling a change of stimulation site depending on the patient's response.MethodsThis study used the medical records of 14 patients from 4 different Spanish institutions: 7 from the Hospital Universitario La Princesa, 3 from the Hospital Universitario Central de Asturias, 2 from Hospital Universitario Fundación Jiménez Díaz, and 2 from Hospital Universitari Son Espases. All patients were operated on under the same protocol. Qualitative and quantitative data were collected.ResultsOf 14 patients, 11 showed significant improvement in obsessive-compulsive disorder symptoms, as evident in a reduction ≥35% in Yale-Brown Obsessive Compulsive Scale scores following stimulation relative to preoperative scores. Seven patients responded to stimulation at the nucleus accumbens (the first area we set for stimulation), whereas 4 patients needed to have the active contact switched to the internal capsule to benefit from stimulation.ConclusionsDeep brain stimulation of the nucleus accumbens, internal capsule, and ventral striatum significantly benefited our cohort of patients with medication-resistant obsessive-compulsive disorder. Electrode insertion through the 3 main targets might confer additional therapeutic efficacy.Copyright © 2021 Elsevier Inc. All rights reserved.

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