• Dirk De Ridder, Sook Ling Leong, Patrick Manning, Sven Vanneste, and Paul Glue.
• Section of Neurosurgery, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, New Zealand. Electronic address: sven.vanneste@utdallas.edu.
• World Neurosurg. 2017 Jan 1; 97: 754.e7-754.e16.

BackgroundObsessive-compulsive disorder (OCD) is a brain disorder with a lifetime prevalence of 2.3%, causing severe functional impairment as a result of anxiety and distress, persistent and repetitive, unwanted, intrusive thoughts (obsessions), and repetitive ritualized behavior (compulsions). Approximately 40%-60% of patients with OCD fail to satisfactorily respond to standard treatments. Intractable OCD has been treated by anterior capsulotomy and cingulotomy, but more recently, neurostimulation approaches have become more popular because of their reversibility.ObjectiveImplants for OCD are commonly being used, targeting the anterior limb of the internal capsula or the nucleus accumbens, but an implant on the anterior cingulate cortex has never been reported.MethodsWe describe a patient who was primarily treated for alcohol addiction, first with transcranial magnetic stimulation, then by implantation of 2 electrodes overlying the rostrodorsal part of the anterior cingulate cortex bilaterally.ResultsHer alcohol addiction developed as she was relief drinking to self-treat her OCD, anxiety, and depression. After the surgical implant, she underwent placebo stimulation followed by real stimulation of the dorsal anterior cingulate cortex, which dramatically improved her OCD symptoms (decrease of 65.5% on the Yale-Brown Obsessive Compulsive Drinking Scale) as well as her alcohol craving (decrease of 87.5%) after 36 weeks of treatment. Although there were improvements in all the scores, there was only a modest reduction in the patient's weekly alcohol consumption (from 50 units to 32 units).ConclusionsBased on these preliminary positive results we propose to further study the possible beneficial effect of anterior cingulate cortex stimulation for intractable OCD.Copyright © 2016 Elsevier Inc. All rights reserved.

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