Treatment of patients with intractable obsessive—compulsive disorder with anterior capsular stimulation

Case report

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✓ Obsessive—compulsive disorder (OCD) is a common, chronic, disabling anxiety disorder characterized by recurrent obsessive thoughts and uncontrolled repetitive acts. Although many patients respond to various pharmacological treatments, there is a cohort of patients with intractable or refractory disease. The authors present the case of a patient with intractable OCD who was treated with bilateral electrical stimulators, which were stereotactically placed in the anterior limbs of the internal capsules.

Following psychiatric consultation and 10 years of empirical medication regimens for OCD, a woman was referred for neurosurgical evaluation. After informed consent had been obtained from the patient, the authors placed bilateral stimulator leads in the anterior limbs of the internal capsules. The stereotactic coordinates were based on data in pertinent current literature. The stimulation parameters, which are presented in this paper, were set at 2 weeks and reviewed at 6 weeks and 3 months postoperatively. No changes were required. Postoperative analysis included evaluation by the patient's referring psychiatrist, a second independent psychiatrist, and pre- and postoperative administration of the Yale—Brown Obsessive Compulsive Scale. A marked improvement was noted in this patient's OCD symptomatology and general psychosocial function.

Previous documentation of patient responses to psychosurgical procedures for intractable or refractory OCD has been met with little enthusiasm, presumably because of the invasiveness and irreversibility of the surgery. In this report the authors suggest that deep brain stimulation of appropriate targets may be an effective and safe treatment for certain patients with OCD and a potentially reversible treatment for those patients who do not obtain therapeutic benefit.

Article Information

Address reprint requests to: Douglas Anderson, M.D., Department of Neurological Surgery, Loyola University Medical Center, 2160 South First Avenue, Maywood, Illinois 60153. email: dander1@lumc.edu.

© AANS, except where prohibited by US copyright law.

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    Preoperative and postoperative scores on the Y-BOCS.

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    Left: Page from the Talairach stereotactic atlas. Reprinted with permission from Talairach J, Tournoux P: Co-Planar Stereotaxic Atlas of the Human Brain: 3-Dimensional Proportional System: An Approach to Cerebral Imaging. New York: Thieme, 1988. Figure 117, page 97. Center: Axial MR image demonstrating the stimulator target at the anterior limb of the internal capsule at the level of the foramen of Monro. Right: Axial CT scan demonstrating electrodes at the anterior limb of the internal capsule at the level of the foramen of Monro.

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