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Current Status of Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Clinical Review of Different Targets

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Abstract

Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder that affects 2% of the general population. Despite optimal cognitive-behavioral and pharmacologic therapy, approximately 10% of patients remain treatment resistant. Currently, deep brain stimulation (DBS) is being investigated as an experimental therapy for treatment-refractory OCD. This review focuses on the efficacy and adverse events of all published DBS targets for OCD: anterior limb of the internal capsule, ventral striatum/ventral capsule, nucleus accumbens, nucleus subthalamicus, and inferior thalamic peduncle. Small studies with various designs indicate an overall average Yale-Brown Obsessive Compulsive Scale score decrease ranging from 6.8 to 31 points. The average overall responder rate is ±50%. The frequency of adverse events seems to be limited. Larger prospective studies including neuroimaging are needed to estimate adequately the true potential of DBS in treatment of OCD and to elucidate its underlying mechanism of action and optimal brain target. We conclude that DBS may be a promising and safe therapy for treatment-resistant OCD.

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Disclosure

Dr. Schuurman has served as a consultant for, received honoraria for service on an expert safety board from, and had travel expenses reimbursed by Medtronic. Drs. De Koning, Figee, van den Munckhof, and Denys reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Department of Psychiatry, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands

    Pelle P. de Koning & Martijn Figee

  2. Department of Neurosurgery, Academic Medical Center, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands

    Pepijn van den Munckhof & P. Richard Schuurman

  3. Department of Psychiatry, Academic Medical Center, University of Amsterdam, PA.2-179, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands

    Damiaan Denys

  4. The Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands

    Damiaan Denys

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  1. Pelle P. de Koning
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  2. Martijn Figee
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  3. Pepijn van den Munckhof
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  4. P. Richard Schuurman
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  5. Damiaan Denys
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Correspondence to Damiaan Denys.

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de Koning, P.P., Figee, M., van den Munckhof, P. et al. Current Status of Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Clinical Review of Different Targets. Curr Psychiatry Rep 13, 274–282 (2011). https://doi.org/10.1007/s11920-011-0200-8

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  • DOI: https://doi.org/10.1007/s11920-011-0200-8

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