Active Stimulation Site of Nucleus Accumbens Deep Brain Stimulation in Obsessive–Compulsive Disorder Is Localized in the Ventral Internal Capsule
Obsessive–compulsive disorder (OCD) is a chronic psychiatric disorder characterized by persistent thoughts and repetitive ritualistic behaviours. Despite optimal cognitive–behavioral and pharmacological therapy, approximately 10 % of patients remain treatment-resistant. Deep brain stimulation (DBS) is being investigated as experimental therapy for treatment-refractory OCD. In the current study, we determined the relationship between anatomical location of active electrode contacts and clinical outcome in 16 OCD patients undergoing bilateral nucleus accumbens (NAc) DBS. We found that most patients actually do not receive active stimulation in the NAc but in the more laterally, anteriorly and dorsally located ventral part of the anterior limb of the internal capsule, ventral ALIC (vALIC). Our nine patients receiving bilateral vALIC DBS improved on average 73 % on their Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) scores, whereas the six patients with their centers of stimulation located otherwise improved on average only 42 %. We therefore propose bilateral vALIC as a promising new DBS target for patients with treatment-refractory OCD. Future studies employing a direct vALIC targeting approach in larger patient numbers are needed to test whether this proposal holds true.
KeywordsObsessive–compulsive disorder Deep brain stimulation Nucleus accumbens Ventral part of the anterior limb of the internal capsule
Conflict of Interest
The DBS devices used in the current patients were provided by Medtronic in the form of an unrestricted investigator-initiated research grant to Dr Denys and Dr Schuurman during the original study by Denys et al. . The department of neurosurgery of the AMC has received an unrestricted grant for movement disorders research from Medtronic. Dr van den Munckhof has received travel grants from Medtronic. Dr Schuurman has received travel grants from Medtronic, and acts as independent advisor for Medtronic on educational matters. No other financial interest or potential conflicts are reported.
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