Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive—compulsive disorder and major depression

Case report

Restricted access

✓ Obsessive—compulsive disorder (OCD) is an anxiety disorder associated with recurrent intrusive thoughts and repetitive behaviors. Although conventional pharmacological and/or psychological treatments are well established and effective in treating OCD, symptoms remain unchanged in up to 30% of patients. Deep brain stimulation (DBS) of the anterior limb of the internal capsule has recently been proposed as a possible therapeutic alternative in treatment-resistant OCD. In the present study, the authors tested the hypothesis that DBS of the ventral caudate nucleus might be effective in a patient with intractable severe OCD and concomitant major depression. Psychiatric assessment included the Yale—Brown Obsessive Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), and the Global Assessment of Functioning (GAF) Scale for determining the symptom severity of OCD, depression, and anxiety as well as the quality of pychosocial and occupational functioning, respectively. Neuropsychological assessment consisted of a wide range of tests primarily exploring memory and executive functions. Deep brain stimulation of the ventral caudate nucleus markedly improved symptoms of depression and anxiety until their remission, which was achieved at 6 months after the start of stimulation (HDRS ≤ 7 and HARS ≤ 10). Remission of OCD (Y-BOCS < 16) was also delayed after 12 or 15 months of DBS. The level of functioning pursuant to the GAF scale progressively increased during the 15-month follow-up period. No neuropsychological deterioration was observed, indicating that DBS of the ventral caudate nucleus could be a promising strategy in the treatment of refractory cases of both OCD and major depression.

Article Information

Contributor Notes

Address reprint requests to: Emmanuel Cuny, M.D., Service de Neurochirurgie, Centre Hospitalier Pellegrin, Place Amélie-Rabat Léon, 33076 Bordeaux, France. email: emmanuel.cuny@chu-bordeaux.fr.
Headings
References
  • 1.

    American Psychiatric Association (ed): Diagnostic and Statistical Manual of Mental Disordersed 4. Washington, DC: American Psychiatric Association1994American Psychiatric Association (ed): Diagnostic and Statistical Manual of Mental Disorders ed 4. Washington DC: American Psychiatric Association 1994

    • Search Google Scholar
    • Export Citation
  • 2.

    Anderson DAhmed A: Treatment of patients with intractable obsessive—compulsive disorder with anterior capsular stimulation. Case report. J Neurosurg 98:110411082003Anderson D Ahmed A: Treatment of patients with intractable obsessive—compulsive disorder with anterior capsular stimulation. Case report. J Neurosurg 98:1104–1108 2003

    • Search Google Scholar
    • Export Citation
  • 3.

    Antony MMDownie FSwinson RP: Diagnostic issues and epidemiology in obsessive-compulsive disorder in Swinson RPAntony MMRachman Set al (eds): Obsessive-Compulsive Disorder: Theory Research and Treatment. New York: Guilford Press1998 pp 332Antony MM Downie F Swinson RP: Diagnostic issues and epidemiology in obsessive-compulsive disorder in Swinson RP Antony MM Rachman S et al (eds): Obsessive-Compulsive Disorder: Theory Research and Treatment. New York: Guilford Press 1998 pp 3–32

    • Search Google Scholar
    • Export Citation
  • 4.

    Ballenger JC: Clinical guidelines for establishing remission in patients with depression and anxiety. J Clin Psychiatry 60 (Suppl 22):29341999Ballenger JC: Clinical guidelines for establishing remission in patients with depression and anxiety. J Clin Psychiatry 60 (Suppl 22):29–34 1999

    • Search Google Scholar
    • Export Citation
  • 5.

    Bar-Gad IBergman H: Stepping out of the box: information processing in the neural networks of the basal ganglia. Curr Opin Neurobiol 11:6896952001Bar-Gad I Bergman H: Stepping out of the box: information processing in the neural networks of the basal ganglia. Curr Opin Neurobiol 11:689–695 2001

    • Search Google Scholar
    • Export Citation
  • 6.

    Baxter LR: Functional imaging of brain systems mediating obsessive-compulsive disorder: clinical studies in Charney DSNestler EJBunney BS (eds): Neurobiology of Mental Illness. New York: Oxford University Press1999 pp 534547Baxter LR: Functional imaging of brain systems mediating obsessive-compulsive disorder: clinical studies in Charney DS Nestler EJ Bunney BS (eds): Neurobiology of Mental Illness. New York: Oxford University Press 1999 pp 534–547

    • Search Google Scholar
    • Export Citation
  • 7.

    Benton AL: The Revised Visual Retention Test: Clinical and Experimental Applications. New York: Psychological Corp1963Benton AL: The Revised Visual Retention Test: Clinical and Experimental Applications. New York: Psychological Corp 1963

    • Search Google Scholar
    • Export Citation
  • 8.

    Breiter HCRauch SLKwong KKet al: Functional magnetic resonance imaging of symptom provocation in obsessive-compulsive disorder. Arch Gen Psychiatry 53:5956061996Breiter HC Rauch SL Kwong KK et al: Functional magnetic resonance imaging of symptom provocation in obsessive-compulsive disorder. Arch Gen Psychiatry 53:595–606 1996

    • Search Google Scholar
    • Export Citation
  • 9.

    Cummings JL: Frontal-subcortical circuits and human behavior. Arch Neurol 50:8738801993Cummings JL: Frontal-subcortical circuits and human behavior. Arch Neurol 50:873–880 1993

    • Search Google Scholar
    • Export Citation
  • 10.

    Cuny EGuehl DBurbaud Pet al: Lack of agreement between direct magnetic resonance imaging and statistical determination of a subthalamic target: the role of electrophysiological guidance. J Neurosurg 97:5915972002Cuny E Guehl D Burbaud P et al: Lack of agreement between direct magnetic resonance imaging and statistical determination of a subthalamic target: the role of electrophysiological guidance. J Neurosurg 97:591–597 2002

    • Search Google Scholar
    • Export Citation
  • 11.

    Dougherty DDBaer LCosgrove GRet al: Prospective long-term follow-up of 44 patients who received cingulotomy for treatmentrefractory obsessive-compulsive disorder. Am J Psychiatry 159:2692752002Dougherty DD Baer L Cosgrove GR et al: Prospective long-term follow-up of 44 patients who received cingulotomy for treatmentrefractory obsessive-compulsive disorder. Am J Psychiatry 159:269–275 2002

    • Search Google Scholar
    • Export Citation
  • 12.

    Drevets WC: Neuroimaging and neuropathological studies of depression: implications for the cognitive-emotional features of mood disorders. Curr Opin Neurobiol 11:2402492001Drevets WC: Neuroimaging and neuropathological studies of depression: implications for the cognitive-emotional features of mood disorders. Curr Opin Neurobiol 11:240–249 2001

    • Search Google Scholar
    • Export Citation
  • 13.

    Drevets WC: Neuroimaging studies of mood disorders. Biol Psychiatry 48:8138292000Drevets WC: Neuroimaging studies of mood disorders. Biol Psychiatry 48:813–829 2000

    • Search Google Scholar
    • Export Citation
  • 14.

    Foa EBFranklin MEKozak MJ: Psychosocial treatments for obsessive-compulsive disorder. Literature review in Swinson RPAntony MMRachman Set al (eds): Obsessive-Compulsive Disorder: Theory Research and Treatment. New-York: Guilford Press1998 pp 258276Foa EB Franklin ME Kozak MJ: Psychosocial treatments for obsessive-compulsive disorder. Literature review in Swinson RP Antony MM Rachman S et al (eds): Obsessive-Compulsive Disorder: Theory Research and Treatment. New-York: Guilford Press 1998 pp 258–276

    • Search Google Scholar
    • Export Citation
  • 15.

    Gabriels LCosyns PNuttin Bet al: Deep brain stimulation for treatment-refractory obsessive-compulsive disorder: psychopathological and neuropsychological outcome in three cases. Acta Psychiatr Scand 107:2752822003Gabriels L Cosyns P Nuttin B et al: Deep brain stimulation for treatment-refractory obsessive-compulsive disorder: psychopathological and neuropsychological outcome in three cases. Acta Psychiatr Scand 107:275–282 2003

    • Search Google Scholar
    • Export Citation
  • 16.

    Goodman WKPrice LHRasmussen SAet al: The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 46:100610111989Goodman WK Price LH Rasmussen SA et al: The Yale-Brown Obsessive Compulsive Scale. I. Development use and reliability. Arch Gen Psychiatry 46:1006–1011 1989

    • Search Google Scholar
    • Export Citation
  • 17.

    Grober EBuschke HCrystal Het al: Screening for dementia by memory testing. Neurology 38:9009031988Grober E Buschke H Crystal H et al: Screening for dementia by memory testing. Neurology 38:900–903 1988

    • Search Google Scholar
    • Export Citation
  • 18.

    Hamilton M: The assessment of anxiety states by rating. Br J Med Psychol 32:50551959Hamilton M: The assessment of anxiety states by rating. Br J Med Psychol 32:50–55 1959

    • Search Google Scholar
    • Export Citation
  • 19.

    Hamilton M: Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 6:2782961967Hamilton M: Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 6:278–296 1967

    • Search Google Scholar
    • Export Citation
  • 20.

    Heaton RKChelune GJTalley JLet al: Wisconsin Card Sorting Test Manual: Revised and Expanded. Odessa, FL: Psychological Assessment Resources1993Heaton RK Chelune GJ Talley JL et al: Wisconsin Card Sorting Test Manual: Revised and Expanded. Odessa FL: Psychological Assessment Resources 1993

    • Search Google Scholar
    • Export Citation
  • 21.

    Isaacs BKennie AT: The Set test as an aid to the detection of dementia in old people. Br J Psychiatry 123:4674701973Isaacs B Kennie AT: The Set test as an aid to the detection of dementia in old people. Br J Psychiatry 123:467–470 1973

    • Search Google Scholar
    • Export Citation
  • 22.

    Jenike MA: Neurosurgical treatment of obsessive-compulsive disorder. Br J Psychiatry 35 (Suppl):79901998Jenike MA: Neurosurgical treatment of obsessive-compulsive disorder. Br J Psychiatry 35 (Suppl):79–90 1998

    • Search Google Scholar
    • Export Citation
  • 23.

    Merriam EPThase MEHaas GLet al: Prefrontal cortical dysfunction in depression determined by Wisconsin Card Sorting Test performance. Am J Psychiatry 156:7807821999Merriam EP Thase ME Haas GL et al: Prefrontal cortical dysfunction in depression determined by Wisconsin Card Sorting Test performance. Am J Psychiatry 156:780–782 1999

    • Search Google Scholar
    • Export Citation
  • 24.

    Nuttin BCosyns PDemeulemeester Het al: Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet 354:15261999 (Letter)Nuttin B Cosyns P Demeulemeester H et al: Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet 354:1526 1999 (Letter)

    • Search Google Scholar
    • Export Citation
  • 25.

    Pallanti SHollander EBienstock Cet al: Treatment non-response in OCD: methodological issues and operational definitions. Int J Neuropsychopharmacol 5:1811912002Pallanti S Hollander E Bienstock C et al: Treatment non-response in OCD: methodological issues and operational definitions. Int J Neuropsychopharmacol 5:181–191 2002

    • Search Google Scholar
    • Export Citation
  • 26.

    Pigott TASeay S: Biological treatments for obsessive-compulsive disorder: clinical applications in Swinson RPAntony MMRachman Set al (eds): Obsessive-Compulsive Disorder: Theory Research and Treatment. New York: Guilford Press1998 pp 298326Pigott TA Seay S: Biological treatments for obsessive-compulsive disorder: clinical applications in Swinson RP Antony MM Rachman S et al (eds): Obsessive-Compulsive Disorder: Theory Research and Treatment. New York: Guilford Press 1998 pp 298–326

    • Search Google Scholar
    • Export Citation
  • 27.

    Rasmussen SAEisen JL: The epidemiology and differential diagnosis of obsessive compulsive disorder. J Clin Psychiatry 53 (Suppl):4101992Rasmussen SA Eisen JL: The epidemiology and differential diagnosis of obsessive compulsive disorder. J Clin Psychiatry 53 (Suppl):4–10 1992

    • Search Google Scholar
    • Export Citation
  • 28.

    Rauch SLJenike MAAlpert NMet al: Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography. Arch Gen Psychiatry 51:62701994Rauch SL Jenike MA Alpert NM et al: Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography. Arch Gen Psychiatry 51:62–70 1994

    • Search Google Scholar
    • Export Citation
  • 29.

    Reitan RM: Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 8:2712761958Reitan RM: Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 8:271–276 1958

    • Search Google Scholar
    • Export Citation
  • 30.

    Rubin RTVillanueva-Meyer JAnanth Jet al: Regional xenon 133 cerebral blood flow and cerebral technetium 99m HMPAO uptake in unmedicated patients with obsessive-compulsive disorder and matched normal control subjects. Determination by highresolution single-photon emission computed tomography. Arch Gen Psychiatry 49:6957021992Rubin RT Villanueva-Meyer J Ananth J et al: Regional xenon 133 cerebral blood flow and cerebral technetium 99m HMPAO uptake in unmedicated patients with obsessive-compulsive disorder and matched normal control subjects. Determination by highresolution single-photon emission computed tomography. Arch Gen Psychiatry 49:695–702 1992

    • Search Google Scholar
    • Export Citation
  • 31.

    Saxena SBrody ALHo MLet al: Cerebral metabolism in major depression and obsessive-compulsive disorder occurring separately and concurrently. Biol Psychiatry 50:1591702001Saxena S Brody AL Ho ML et al: Cerebral metabolism in major depression and obsessive-compulsive disorder occurring separately and concurrently. Biol Psychiatry 50:159–170 2001

    • Search Google Scholar
    • Export Citation
  • 32.

    Schultz WTremblay LHollerman JR: Reward processing in primate orbitofrontal cortex and basal ganglia. Cereb Cortex 10:2722842000Schultz W Tremblay L Hollerman JR: Reward processing in primate orbitofrontal cortex and basal ganglia. Cereb Cortex 10:272–284 2000

    • Search Google Scholar
    • Export Citation
  • 33.

    Sheehan DVLecrubier YSheehan KHet al: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59 (Suppl 20):223334–571998Sheehan DV Lecrubier Y Sheehan KH et al: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59 (Suppl 20):22–33 34–57 1998

    • Search Google Scholar
    • Export Citation
  • 34.

    Stroop JR: Studies of interference in serial verbal reactions. J Exp Psychol 18:6436611935Stroop JR: Studies of interference in serial verbal reactions. J Exp Psychol 18:643–661 1935

    • Search Google Scholar
    • Export Citation
  • 35.

    Zazzo R: Test des deux barrages. Actualités pedagogiques et psychologiques. Neuchâtel: Delachaux et Nestlé1974Zazzo R: Test des deux barrages. Actualités pedagogiques et psychologiques. Neuchâtel: Delachaux et Nestlé 1974

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 463 441 32
Full Text Views 296 137 10
PDF Downloads 179 86 6
EPUB Downloads 0 0 0
PubMed
Google Scholar