Deep brain stimulation of the subthalamic nucleus in obsessive-compulsives disorders: long-term follow-up of an open, prospective, observational cohort.
- Chabardes S CLINATEC, CEA Clinatec-Minatec, Grenoble, France schabardes@chu-grenoble.fr.
- Krack P Division of Neurology, Department of Neurology, Bern University Hospital, Bern, Switzerland, Bern, Switzerland.
- Piallat B Grenoble Institut neurosciences, University Grenoble Alpes-INSERM U1216, 38000 Grenoble, France.
- Bougerol T Department of Psychiatry, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
- Seigneuret E Department of Neurosurgery, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France.
- Yelnik J Institut du Cerveau, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France.
- Fernandez Vidal S Institut du Cerveau, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France.
- David O Grenoble Institut neurosciences, University Grenoble Alpes-INSERM U1216, 38000 Grenoble, France.
- Mallet L Institut du Cerveau, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, F-75013, Paris, France.
- Benabid AL CLINATEC, CEA Clinatec-Minatec, Grenoble, France.
- Polosan M Grenoble Institut neurosciences, University Grenoble Alpes-INSERM U1216, 38000 Grenoble, France.
- 2020-10-09
Published in:
- Journal of neurology, neurosurgery, and psychiatry. - 2020
English
BACKGROUND
Obsessive-compulsive disorder (OCD) is a major cause of disability in western country and responsible for severe impairment of quality of life. About 10% of patients present with severe OCD symptoms and require innovative treatment such as deep brain stimulation (DBS). Among possible targets, the non-motor subthalamic nucleus (STN) is a key node of the basal ganglia circuitry, strongly connected to limbic cortical areas known to be involved in OCD.
METHOD
We analysed, in a prospective, observational, monocentric, open label cohort, the effect of chronic non-motor STN-DBS in 19 patients with treatment-resistant OCD consecutively operated in a single centre. Severity of OCD was evaluated using the Yale and Brown Obsessive-Compulsive Scale (YBOCS). YBOCS scores at 6, 12 and 24 months postoperatively were compared with baseline. Responders were defined by >35% improvement of YBOCS scores. Global Assessment Functioning (GAF) scale was used to evaluate the impact of improvement.
RESULTS
At a 24-month follow-up, the mean YBOCS score improved by 53.4% from 33.3±3.5 to 15.8±9.1 (95% CI 11.2-20.4; p<0.0001). Fourteen out of 19 patients were considered as responders, 5 out of 19 being improved over 75% and 10 out of 19 over 50%. GAF scale improved by 92% from 34.1±3.9 to 66.4±18.8 (95% CI 56.7-76.1; p=0.0003). The most frequent adverse events consisted of transient DBS-induced hypomania and anxiety.
CONCLUSION
Chronic DBS of the non-motor STN is an effective and relatively safe procedure to treat severe OCD resistant to conventional management.
Obsessive-compulsive disorder (OCD) is a major cause of disability in western country and responsible for severe impairment of quality of life. About 10% of patients present with severe OCD symptoms and require innovative treatment such as deep brain stimulation (DBS). Among possible targets, the non-motor subthalamic nucleus (STN) is a key node of the basal ganglia circuitry, strongly connected to limbic cortical areas known to be involved in OCD.
METHOD
We analysed, in a prospective, observational, monocentric, open label cohort, the effect of chronic non-motor STN-DBS in 19 patients with treatment-resistant OCD consecutively operated in a single centre. Severity of OCD was evaluated using the Yale and Brown Obsessive-Compulsive Scale (YBOCS). YBOCS scores at 6, 12 and 24 months postoperatively were compared with baseline. Responders were defined by >35% improvement of YBOCS scores. Global Assessment Functioning (GAF) scale was used to evaluate the impact of improvement.
RESULTS
At a 24-month follow-up, the mean YBOCS score improved by 53.4% from 33.3±3.5 to 15.8±9.1 (95% CI 11.2-20.4; p<0.0001). Fourteen out of 19 patients were considered as responders, 5 out of 19 being improved over 75% and 10 out of 19 over 50%. GAF scale improved by 92% from 34.1±3.9 to 66.4±18.8 (95% CI 56.7-76.1; p=0.0003). The most frequent adverse events consisted of transient DBS-induced hypomania and anxiety.
CONCLUSION
Chronic DBS of the non-motor STN is an effective and relatively safe procedure to treat severe OCD resistant to conventional management.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
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- DOI 10.1136/jnnp-2020-323421
- PMID 33033168
- Persistent URL
- https://sonar.ch/global/documents/47310
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