Active Stimulation Site of Nucleus Accumbens Deep Brain Stimulation in Obsessive–Compulsive Disorder Is Localized in the Ventral Internal Capsule

  • Pepijn van den MunckhofEmail author
  • D. Andries Bosch
  • Mariska H. M. Mantione
  • Martijn Figee
  • Damiaan A. J. P. Denys
  • P. Richard Schuurman
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 117)


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.


Obsessive–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. [3]. 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.


  1. 1.
    Abelson JL, Curtis GC, Sagher O, Albucher RC, Harrigan M, Taylor SF, Martis B, Giordani B (2005) Deep brain stimulation for refractory obsessive-compulsive disorder. Biol Psychiatry 57:510–516PubMedCrossRefGoogle Scholar
  2. 2.
    Denys D (2006) Pharmacotherapy of obsessive-compulsive disorder and obsessive-compulsive spectrum disorders. Psychiatr Clin North Am 29:553–584PubMedCrossRefGoogle Scholar
  3. 3.
    Denys D, Mantione M, Figee M, van den Munckhof P, Koerselman F, Westenberg H, Bosch DA, Schuurman PR (2010) Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Arch Gen Psychiatry 67:1061–1068PubMedCrossRefGoogle Scholar
  4. 4.
    First MB, Spitzer RL, Gibbon MG, Williams JB (1997) Structured clinical interview for DSM-IV Axis I disorders (SCID-I): clinical version. American Psychiatric Press, Washington, D.CGoogle Scholar
  5. 5.
    Goodman WK, Foote KD, Greenberg BD, Ricciuti N, Bauer R, Ward H, Shapira NA, Wu SS, Hill CL, Rasmussen SA, Okun MS (2010) Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded staggered-onset design. Biol Psychiatry 67:535–542PubMedCrossRefGoogle Scholar
  6. 6.
    Goodman WK, Price LH, Rasmussen SA, Mazure C, Delgado P, Heninger GR, Charney DS (1989) The Yale-Brown Obsessive Compulsive Scale, II: validity. Arch Gen Psychiatry 46:1012–1016PubMedCrossRefGoogle Scholar
  7. 7.
    Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, Heninger GR, Charney DS (1989) The Yale-Brown Obsessive Compulsive Scale, I: development, use, and reliability. Arch Gen Psychiatry 46:1006–1011PubMedCrossRefGoogle Scholar
  8. 8.
    Greenberg BD, Gabriels LA, Malone DA Jr, Rezai AR, Friehs GM, Okun MS, Shapira NA, Foote KD, Cosyns PR, Kubu CS, Malloy PF, Salloway SP, Giftakis JE, Rise MT, Machado AG, Baker KB, Stypulkowski PH, Goodman WK, Rasmussen SA, Nuttin BJ (2010) Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry 15:64–79PubMedCrossRefGoogle Scholar
  9. 9.
    Greenberg BD, Rauch SL, Haber SN (2010) Invasive circuitry-based neurotherapeutics: stereotactic ablation and deep brain stimulation for OCD. Neuropsychopharamcology 35:317–336CrossRefGoogle Scholar
  10. 10.
    Gutman DA, Holtzheimer PE, Behrens TEJ, Johansen-Beerg H, Mayberg HS (2009) A tractography analysis of two deep brain stimulation white matter targets for depression. Biol Psychiatry 65:276–282PubMedCrossRefGoogle Scholar
  11. 11.
    Haynes WIA, Mallet L (2010) High-frequency stimulation of deep brain structures in obsessive-compulsive disorders: the search for a valid circuit. Eur J Neurosci 32:1118–1127PubMedCrossRefGoogle Scholar
  12. 12.
    Mai JK, Assheuer J, Paxinos G (1997) Atlas of the human brain. Academic, San DiegoGoogle Scholar
  13. 13.
    Mallet L, Polosan M, Jaafari N, Baup N, Welter ML, Fontaine O, du Montcel ST, Yelnik J, Chéreau I, Arbus C, Raoul S, Aouizerate B, Damier P, Chabardès S, Czernecki V, Ardouin C, Krebs MO, Bardinet E, Chaynes P, Burbaud P, Cornu P, Derost P, Bougerol T, Bataille B, Mattei V, Dormont D, Devaux B, Vérin M, Houeto JL, Pollak P, Benabid AL, Agid Y, Krack P, Millet B, Pelissolo A, STOC Study Group (2008) Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med 359:2121–2134PubMedCrossRefGoogle Scholar
  14. 14.
    Morel A (2007) Stereotactic atlas of the human thalamus and basal ganglia. Informa Healthcare, New YorkCrossRefGoogle Scholar
  15. 15.
    Nuttin B, Cosyns P, Demeulemeester H, Gybels J, Meyerson B (1999) Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet 354:1526PubMedCrossRefGoogle Scholar
  16. 16.
    Nuttin BJ, Gabriëls LA, Cosyns PR, Meyerson BA, Andréewitch S, Sunaert SG, Maes AF, Dupont PJ, Gybels JM, Gielen F, Demeulemeester HG (2003) Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder. Neurosurgery 52:1263–1272PubMedCrossRefGoogle Scholar
  17. 17.
    Van den Munckhof P, Contarino MF, Bour LJ, Speelman JD, de Bie RMA, Schuurman PR (2010) Postoperative curving and upward displacement of deep brain stimulation electrodes caused by brain shift. Neurosurgery 67:49–54PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Pepijn van den Munckhof
    • 1
    Email author
  • D. Andries Bosch
    • 1
  • Mariska H. M. Mantione
    • 2
  • Martijn Figee
    • 2
  • Damiaan A. J. P. Denys
    • 2
  • P. Richard Schuurman
    • 1
  1. 1.Department of Neurosurgery H2-238, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Psychiatry, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands

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