Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder
Faculty of Medicine and Health Sciences
Neurosurgery. - Baltimore, Md, 1977, currens
, p. 1263-1272
University of Antwerp
OBJECTIVE:. Because of the irreversibility of lesioning procedures and their possible side effects, we studied the efficacy of replacing bilateral anterior capsulotomy with chronic electrical capsular stimulation in patients with severe, long-standing treatment-resistant obsessive-compulsive disorder. METHODS: We-stereotactically implanted quadripolar electrodes in both anterior limbs of the internal capsules into six patients with severe obsessive-compulsive disorder. Psychiatrists and psychologists performed a double-blind clinical assessment. A blinded random crossover design was used to assess four of those patients, who underwent continuous stimulation thereafter. RESULTS: The psychiatrist-rated Yale-Brown Obsessive Compulsive Scale score was lower in the stimulation-on condition (mean, 19.8 +/- 8.0) than in the postoperative stimulator-off condition (mean, 32.3 +/- 3.9), and, this stimulation-induced effect was maintained for at least 21 months' after surgery. The Clinical Global Severity. score decreased from 5 (severe; standard deviation, 0) in the stimulation-off condition (moderate to moderate-severe; standard deviation, 0.96) in the stimulation-on condition. The Clinical Global Improvement scores were unchanged in one patient and much improved in the other three during Stimulation. During the stimulation-off period, symptom severity approached baseline levels in the four patients. Bilateral stimulation led to increased signal on functional magnetic resonance imaging studies,, especially in the pons. Digital subtraction analysis of preoperative [F-18]2-fluoro-2-deoxy-D-glucose positron emission tomographic scans and positron emission tomographic scans obtained after 3 months of stimulation showed decreased frontal metabolism during stimulation. CONCLUSION: These observations indicate that capsular stimulation reduces,core symptoms 21 months after surgery in patients severe, long-standing, treatment in patients wit refractory obsessive-compulsive disorder. The stimulation elicited changes in regional brain activity as measured by functional magnetic resonance imaging and positron emission tomography.