Electrophysiological and imaging evidence of sustained inhibition in limbic and frontal networks following deep brain stimulation for treatment refractory obsessive compulsive disorder

• Published in: PloS one 2019-07, Vol.14 (7), p.e0219578-e0219578
• Main Authors: Park, Hye Ran, Kim, In Hyang, Kang, Hyejin, McCairn, Kevin W, Lee, Dong Soo, Kim, Bung-Nyun, Kim, Dong Gyu, Paek, Sun Ha
• Format: Article
• Language: English
• Subjects: Adult; Biology and Life Sciences; Brain; Brain - diagnostic imaging; Brain research; Brain stimulation; Care and treatment; Cortex; Deep brain stimulation; Deep Brain Stimulation - methods; Electrodes; Electrophysiological Phenomena; Electrophysiology; Engineering and Technology; Fluorodeoxyglucose F18; Frontal Lobe - physiology; Genetic factors; Hospitals; Humans; Inhibition; Internal Capsule; Limbic System - physiology; Magnetic Resonance Imaging; Male; Medical imaging; Medicine and Health Sciences; Mental disorders; Metabolism; Nervous system diseases; Neuroimaging; Neurons - physiology; Neurosciences; Neuroses; Neurosurgery; Nuclear medicine; Nucleus accumbens; Nucleus Accumbens - physiology; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - therapy; Patients; Pets; Pharmacology; Positron emission; Positron emission tomography; Psychiatric Status Rating Scales; Psychiatry; Recovery of function; Reduction; Research and Analysis Methods; Stimulation; Tomography; Treatment Outcome; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0219578

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that arises from a complex interaction of environmental and genetic factors. Despite numerous pharmacological and behavioral interventions, approximately 10% of patients remain refractory. High-frequency deep brain stimulation (HF-DBS) has shown promising results for treatment-refractory OCD. We report the follow-up result of up to 6 years of 4 treatment-refractory OCD patients treated by HF-DBS. Targets of stimulation were the anterior limb of the internal capsule (ALIC) in two cases, and the nucleus accumbens (NAc) in the remaining cohort. The clinical profiles were quantified by the Yale-Brown obsessive-compulsive scale (Y-BOCS). Highly significant reductions in Y-BOCS scores were obtained from all patients during the follow-up period. A greater that 90% reduction in Y-BOCS, observed in the most successful case, was achieved with NAc HF-DBS. Y-BOCS scores in the other patients consistently achieved over 50% reductions in OCD symptoms. FDG-PET imaging indicated post-surgical reductions in metabolism, in not only targeted limbic networks, but also other frontal cortical and subcortical regions, suggesting that large-scale network modulation and inhibitions are associated with functional recovery in OCD. This study demonstrates that HF-DBS targeted to the ALIC and NAc is a safe and effective method for ameliorating intractable, treatment-refractory OCD symptoms. The NAc appeared to be the superior target for symptom reduction, and local inhibition of NAc activity and reduced frontal metabolism are key therapeutic indications.