Deep Brain Stimulation in the Bed Nucleus of Stria Terminalis in Obsessive-Compulsive Disorder—1-Year Follow-up

Deep brain stimulation (DBS) is under investigation as a treatment for therapy-refractory obsessive-compulsive disorder (OCD). As a crucial part of the anxiety circuit, the bed nucleus of stria terminalis (BNST) has been proposed as a target for DBS in OCD. Here, we investigate clinical outcomes and...

Full description

Saved in:
Bibliographic Details
Published in:World neurosurgery 2021-05, Vol.149, p.e794-e802
Main Authors: Naesström, Matilda, Hariz, Marwan, Strömsten, Lotta, Bodlund, Owe, Blomstedt, Patric
Format: Article
Language:English
Subjects:
Bed nucleus of stria terminalis
Deep brain stimulation
Obsessive-compulsive disorder
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c438t-33f3bd69978274bc16091318456513742f7f3a0a2669421eb290471732799663
cites cdi_FETCH-LOGICAL-c438t-33f3bd69978274bc16091318456513742f7f3a0a2669421eb290471732799663
container_end_page e802
container_issue
container_start_page e794
container_title World neurosurgery
container_volume 149
creator Naesström, Matilda
Hariz, Marwan
Strömsten, Lotta
Bodlund, Owe
Blomstedt, Patric
description Deep brain stimulation (DBS) is under investigation as a treatment for therapy-refractory obsessive-compulsive disorder (OCD). As a crucial part of the anxiety circuit, the bed nucleus of stria terminalis (BNST) has been proposed as a target for DBS in OCD. Here, we investigate clinical outcomes and safety of DBS in the BNST in a series of 11 participants with severe therapy-refractory OCD. Eleven consecutive participants diagnosed with refractory OCD were treated with BNST DBS and completed follow-up. The primary outcome was a change in scores of the Yale Brown Obsessive Compulsive Scale (YBOCS) at 1 year after surgery. Secondary outcomes included changes in scores of the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Global Assessment of Functioning. At baseline, the mean ± SD YBOCS score was 33 ± 3.0, MADRS score was 29 ± 4.5, and GAF score was 49 ± 5.4. One year after DBS, mean ± SD YBOCS score was 20 ± 4.8 (38% improvement (range 10%−60%) P 
doi_str_mv 10.1016/j.wneu.2021.01.097
format article
fullrecord <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_DiVA_org_umu_181842</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1878875021001285</els_id><sourcerecordid>2487157101</sourcerecordid><originalsourceid>FETCH-LOGICAL-c438t-33f3bd69978274bc16091318456513742f7f3a0a2669421eb290471732799663</originalsourceid><addsrcrecordid>eNp9kc9q3DAQxkVpaEKSF-ih6NiLt_pjSxb0kuwmbSEkhy6FnoRsj1stsuVIVpbe-hB9wj5JZTbdY4aBmYHffIfvQ-gtJStKqPiwW-1HSCtGGF2R3Eq-Qme0lnVRS6FeH_eKnKLLGHckF6dlLfkbdMp5VRJK2Bl63ABM-DoYO-Kvsx2SM7P1I87n_BPwNXT4PrUOUsS-z0SwBm8hDHY0zsYFe2gixGifoFj7YUpuWfHGRh86CH9__6HFdzAB33rn_L5I0wU66Y2LcPk8z9H29ma7_lzcPXz6sr66K9qS13PBec-bTiglaybLpqWCKMppXVaiolyWrJc9N8QwIVTJKDRMkVJSyZlUSgh-joqDbNzDlBo9BTuY8Et7Y_XGfrvSPvzQaUia1lmUZf79gZ-Cf0wQZz3Y2IJzZgSfombZOlrJ7H1G2QFtg48xQH8Up0Qv4eidXsLRSzia5FYyP7171k_NAN3x5X8UGfh4ACCb8mQh6NhaGFvobIB21p23L-n_Azian2c</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2487157101</pqid></control><display><type>article</type><title>Deep Brain Stimulation in the Bed Nucleus of Stria Terminalis in Obsessive-Compulsive Disorder—1-Year Follow-up</title><source>ScienceDirect Journals</source><creator>Naesström, Matilda ; Hariz, Marwan ; Strömsten, Lotta ; Bodlund, Owe ; Blomstedt, Patric</creator><creatorcontrib>Naesström, Matilda ; Hariz, Marwan ; Strömsten, Lotta ; Bodlund, Owe ; Blomstedt, Patric</creatorcontrib><description>Deep brain stimulation (DBS) is under investigation as a treatment for therapy-refractory obsessive-compulsive disorder (OCD). As a crucial part of the anxiety circuit, the bed nucleus of stria terminalis (BNST) has been proposed as a target for DBS in OCD. Here, we investigate clinical outcomes and safety of DBS in the BNST in a series of 11 participants with severe therapy-refractory OCD. Eleven consecutive participants diagnosed with refractory OCD were treated with BNST DBS and completed follow-up. The primary outcome was a change in scores of the Yale Brown Obsessive Compulsive Scale (YBOCS) at 1 year after surgery. Secondary outcomes included changes in scores of the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Global Assessment of Functioning. At baseline, the mean ± SD YBOCS score was 33 ± 3.0, MADRS score was 29 ± 4.5, and GAF score was 49 ± 5.4. One year after DBS, mean ± SD YBOCS score was 20 ± 4.8 (38% improvement (range 10%−60%) P &lt; 0.01), MADRS score was 21 ± 5.8 (27% improvement, range 4%−74%, P &lt; 0.01), and Global Assessment of Functioning score was 55 ± 6.5 (12% improvement, range 4%−29%, P &lt; 0.05). Of the 11 participants, 6 were considered responders (decrease in YBOCS ≥35%) and 4 partial responders (decrease in YBOCS 25%−34%). Surgical adverse events included 1 case of skin infection leading to reimplantation. The most common transient stimulation-related side effects were anxiety and insomnia. BNST DBS is a promising therapy in severe therapy-refractory OCD. Our results are in line with previous publications regarding effect and safety profile. Nevertheless, DBS for OCD remains an investigational therapy and should therefore be performed in multidisciplinary clinical studies.</description><identifier>ISSN: 1878-8750</identifier><identifier>ISSN: 1878-8769</identifier><identifier>EISSN: 1878-8769</identifier><identifier>DOI: 10.1016/j.wneu.2021.01.097</identifier><identifier>PMID: 33540102</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Bed nucleus of stria terminalis ; Deep brain stimulation ; Obsessive-compulsive disorder</subject><ispartof>World neurosurgery, 2021-05, Vol.149, p.e794-e802</ispartof><rights>2021 The Authors</rights><rights>Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c438t-33f3bd69978274bc16091318456513742f7f3a0a2669421eb290471732799663</citedby><cites>FETCH-LOGICAL-c438t-33f3bd69978274bc16091318456513742f7f3a0a2669421eb290471732799663</cites><orcidid>0000-0001-5930-6037</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33540102$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-181842$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Naesström, Matilda</creatorcontrib><creatorcontrib>Hariz, Marwan</creatorcontrib><creatorcontrib>Strömsten, Lotta</creatorcontrib><creatorcontrib>Bodlund, Owe</creatorcontrib><creatorcontrib>Blomstedt, Patric</creatorcontrib><title>Deep Brain Stimulation in the Bed Nucleus of Stria Terminalis in Obsessive-Compulsive Disorder—1-Year Follow-up</title><title>World neurosurgery</title><addtitle>World Neurosurg</addtitle><description>Deep brain stimulation (DBS) is under investigation as a treatment for therapy-refractory obsessive-compulsive disorder (OCD). As a crucial part of the anxiety circuit, the bed nucleus of stria terminalis (BNST) has been proposed as a target for DBS in OCD. Here, we investigate clinical outcomes and safety of DBS in the BNST in a series of 11 participants with severe therapy-refractory OCD. Eleven consecutive participants diagnosed with refractory OCD were treated with BNST DBS and completed follow-up. The primary outcome was a change in scores of the Yale Brown Obsessive Compulsive Scale (YBOCS) at 1 year after surgery. Secondary outcomes included changes in scores of the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Global Assessment of Functioning. At baseline, the mean ± SD YBOCS score was 33 ± 3.0, MADRS score was 29 ± 4.5, and GAF score was 49 ± 5.4. One year after DBS, mean ± SD YBOCS score was 20 ± 4.8 (38% improvement (range 10%−60%) P &lt; 0.01), MADRS score was 21 ± 5.8 (27% improvement, range 4%−74%, P &lt; 0.01), and Global Assessment of Functioning score was 55 ± 6.5 (12% improvement, range 4%−29%, P &lt; 0.05). Of the 11 participants, 6 were considered responders (decrease in YBOCS ≥35%) and 4 partial responders (decrease in YBOCS 25%−34%). Surgical adverse events included 1 case of skin infection leading to reimplantation. The most common transient stimulation-related side effects were anxiety and insomnia. BNST DBS is a promising therapy in severe therapy-refractory OCD. Our results are in line with previous publications regarding effect and safety profile. Nevertheless, DBS for OCD remains an investigational therapy and should therefore be performed in multidisciplinary clinical studies.</description><subject>Bed nucleus of stria terminalis</subject><subject>Deep brain stimulation</subject><subject>Obsessive-compulsive disorder</subject><issn>1878-8750</issn><issn>1878-8769</issn><issn>1878-8769</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kc9q3DAQxkVpaEKSF-ih6NiLt_pjSxb0kuwmbSEkhy6FnoRsj1stsuVIVpbe-hB9wj5JZTbdY4aBmYHffIfvQ-gtJStKqPiwW-1HSCtGGF2R3Eq-Qme0lnVRS6FeH_eKnKLLGHckF6dlLfkbdMp5VRJK2Bl63ABM-DoYO-Kvsx2SM7P1I87n_BPwNXT4PrUOUsS-z0SwBm8hDHY0zsYFe2gixGifoFj7YUpuWfHGRh86CH9__6HFdzAB33rn_L5I0wU66Y2LcPk8z9H29ma7_lzcPXz6sr66K9qS13PBec-bTiglaybLpqWCKMppXVaiolyWrJc9N8QwIVTJKDRMkVJSyZlUSgh-joqDbNzDlBo9BTuY8Et7Y_XGfrvSPvzQaUia1lmUZf79gZ-Cf0wQZz3Y2IJzZgSfombZOlrJ7H1G2QFtg48xQH8Up0Qv4eidXsLRSzia5FYyP7171k_NAN3x5X8UGfh4ACCb8mQh6NhaGFvobIB21p23L-n_Azian2c</recordid><startdate>20210501</startdate><enddate>20210501</enddate><creator>Naesström, Matilda</creator><creator>Hariz, Marwan</creator><creator>Strömsten, Lotta</creator><creator>Bodlund, Owe</creator><creator>Blomstedt, Patric</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>ADHXS</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>D93</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0001-5930-6037</orcidid></search><sort><creationdate>20210501</creationdate><title>Deep Brain Stimulation in the Bed Nucleus of Stria Terminalis in Obsessive-Compulsive Disorder—1-Year Follow-up</title><author>Naesström, Matilda ; Hariz, Marwan ; Strömsten, Lotta ; Bodlund, Owe ; Blomstedt, Patric</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c438t-33f3bd69978274bc16091318456513742f7f3a0a2669421eb290471732799663</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Bed nucleus of stria terminalis</topic><topic>Deep brain stimulation</topic><topic>Obsessive-compulsive disorder</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Naesström, Matilda</creatorcontrib><creatorcontrib>Hariz, Marwan</creatorcontrib><creatorcontrib>Strömsten, Lotta</creatorcontrib><creatorcontrib>Bodlund, Owe</creatorcontrib><creatorcontrib>Blomstedt, Patric</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SWEPUB Umeå universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Umeå universitet</collection><collection>SwePub Articles full text</collection><jtitle>World neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Naesström, Matilda</au><au>Hariz, Marwan</au><au>Strömsten, Lotta</au><au>Bodlund, Owe</au><au>Blomstedt, Patric</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Deep Brain Stimulation in the Bed Nucleus of Stria Terminalis in Obsessive-Compulsive Disorder—1-Year Follow-up</atitle><jtitle>World neurosurgery</jtitle><addtitle>World Neurosurg</addtitle><date>2021-05-01</date><risdate>2021</risdate><volume>149</volume><spage>e794</spage><epage>e802</epage><pages>e794-e802</pages><issn>1878-8750</issn><issn>1878-8769</issn><eissn>1878-8769</eissn><abstract>Deep brain stimulation (DBS) is under investigation as a treatment for therapy-refractory obsessive-compulsive disorder (OCD). As a crucial part of the anxiety circuit, the bed nucleus of stria terminalis (BNST) has been proposed as a target for DBS in OCD. Here, we investigate clinical outcomes and safety of DBS in the BNST in a series of 11 participants with severe therapy-refractory OCD. Eleven consecutive participants diagnosed with refractory OCD were treated with BNST DBS and completed follow-up. The primary outcome was a change in scores of the Yale Brown Obsessive Compulsive Scale (YBOCS) at 1 year after surgery. Secondary outcomes included changes in scores of the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Global Assessment of Functioning. At baseline, the mean ± SD YBOCS score was 33 ± 3.0, MADRS score was 29 ± 4.5, and GAF score was 49 ± 5.4. One year after DBS, mean ± SD YBOCS score was 20 ± 4.8 (38% improvement (range 10%−60%) P &lt; 0.01), MADRS score was 21 ± 5.8 (27% improvement, range 4%−74%, P &lt; 0.01), and Global Assessment of Functioning score was 55 ± 6.5 (12% improvement, range 4%−29%, P &lt; 0.05). Of the 11 participants, 6 were considered responders (decrease in YBOCS ≥35%) and 4 partial responders (decrease in YBOCS 25%−34%). Surgical adverse events included 1 case of skin infection leading to reimplantation. The most common transient stimulation-related side effects were anxiety and insomnia. BNST DBS is a promising therapy in severe therapy-refractory OCD. Our results are in line with previous publications regarding effect and safety profile. Nevertheless, DBS for OCD remains an investigational therapy and should therefore be performed in multidisciplinary clinical studies.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33540102</pmid><doi>10.1016/j.wneu.2021.01.097</doi><orcidid>https://orcid.org/0000-0001-5930-6037</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1878-8750
ispartof World neurosurgery, 2021-05, Vol.149, p.e794-e802
issn 1878-8750
1878-8769
1878-8769
language eng
recordid cdi_swepub_primary_oai_DiVA_org_umu_181842
source ScienceDirect Journals
subjects Bed nucleus of stria terminalis
Deep brain stimulation
Obsessive-compulsive disorder
title Deep Brain Stimulation in the Bed Nucleus of Stria Terminalis in Obsessive-Compulsive Disorder—1-Year Follow-up
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-22T19%3A56%3A10IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Deep%20Brain%20Stimulation%20in%20the%20Bed%20Nucleus%20of%20Stria%20Terminalis%20in%20Obsessive-Compulsive%20Disorder%E2%80%941-Year%20Follow-up&rft.jtitle=World%20neurosurgery&rft.au=Naesstr%C3%B6m,%20Matilda&rft.date=2021-05-01&rft.volume=149&rft.spage=e794&rft.epage=e802&rft.pages=e794-e802&rft.issn=1878-8750&rft.eissn=1878-8769&rft_id=info:doi/10.1016/j.wneu.2021.01.097&rft_dat=%3Cproquest_swepu%3E2487157101%3C/proquest_swepu%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c438t-33f3bd69978274bc16091318456513742f7f3a0a2669421eb290471732799663%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2487157101&rft_id=info:pmid/33540102&rfr_iscdi=true