Deep Brain Stimulation of the Nucleus Accumbens, Ventral Striatum, or Internal Capsule Targets for Medication-Resistant Obsessive-Compulsive Disorder: A Multicenter Study.

BACKGROUND: Deep brain stimulation of the nucleus accumbens, ventral striatum, or internal capsule region has shown a 45%-60% response rate in adults with severe treatment-refractory obsessive-compulsive disorder, regardless of which target is used. We sought to improve the effectiveness of deep brain stimulation by placing the electrode along a trajectory including these 3 targets, enabling a change of stimulation site depending on the patient's response. METHODS: This study used the medical records of 14 patients from 4 different Spanish institutions: 7 from the Hospital Universitario La Princesa, 3 from the Hospital Universitario Central de Asturias, 2 from Hospital Universitario Fundación Jiménez Díaz, and 2 from Hospital Universitari Son Espases. All patients were operated on under the same protocol. Qualitative and quantitative data were collected. RESULTS: Of 14 patients, 11 showed significant improvement in obsessive-compulsive disorder symptoms, as evident in a reduction ≥35% in Yale-Brown Obsessive Compulsive Scale scores following stimulation relative to preoperative scores. Seven patients responded to stimulation at the nucleus accumbens (the first area we set for stimulation), whereas 4 patients needed to have the active contact switched to the internal capsule to benefit from stimulation. CONCLUSIONS: Deep brain stimulation of the nucleus accumbens, internal capsule, and ventral striatum significantly benefited our cohort of patients with medication-resistant obsessive-compulsive disorder. Electrode insertion through the 3 main targets might confer additional therapeutic efficacy.

Deep Brain Stimulation in Patients with Parkinson's Disease: Effect on Psychiatric Symptoms and Quality of Life.

BACKGROUND AND STUDY AIMS: To determine the effect on psychiatric symptoms and quality of life in 30 patients with Parkinson's disease (PD) treated with deep brain stimulation (DBS) of both subthalamic nuclei (STN) after 1 year of follow-up. MATERIAL AND METHOD: We conducted a prospective 1-year follow-up study with a baseline assessment before and 6 and 12 months after surgery. The following were used as assessment instruments: the Bech-Rafaelsen Melancholia Scale (MES), the Bech-Rafaelsen Mania Scale (MAS), the Beck Scale for Suicidal Ideation (SSI), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Oviedo Sleep Questionnaire (OSQ), the 36-Item Short Form Health Survey (SF-36), the Unified Parkinson's Disease Rating Scale (UPDRS), the dose of levodopa, and the active contact stereotactic coordinates. RESULTS: We recorded a clinical improvement between baseline with medication use (ON medication) and the results obtained at 6 and 12 months with medication use and stimulation (ON stimulation, ON medication) in MES and OSQ (p < 0.0001) and in SF-36 (p < 0.005). No changes were observed in MAS and SSI. There was a clinical improvement between baseline with ON medication and the results obtained at 12 months with ON stimulation, ON medication in Y-BOCS (p < 0.04). Also, there was a 53.3% reduction in levodopa at 6 months and a 54.7% reduction at 12 months after surgery (p < 0.0001). There was an improvement between baseline with OFF medication and the results obtained at 6 and 12 months OFF medication, ON stimulation (p < 0.0001) in UPDRS-III. There were no statistically significant differences between the initial and final active contact coordinates, or between stimulation parameters. CONCLUSIONS: DBS of the STN in patients with PD is associated with an improvement in psychiatric (affective and sleep-wake cycle) symptoms, clinical motor symptoms, and quality of life at 1 year after surgery.

Lead Fractures in Deep Brain Stimulation during Long-Term Follow-Up.

The purpose was to determine the incidence of lead fracture in patients with DBS over a long period of time. We present a retrospective study of 208 patients who received 387 DBS electrodes. Fourteen patients had sixteen lead fractures (4% of the implanted leads) and two patients suffered from 2 lead fractures. Of all lead fractures, five patients had the connection between the leads and the extension cables located in mastoids region, ten in cervical area and one in thoracic region. The mean distance from the connection between the electrode and the extension cable and the lead fracture was 10.7 mm. The lead fracture is a common, although long-term complication in DBS surgery. In our experience, the most common site of electrode cable breakage is approximately between 9 and 13 mm from the junction between the lead and the extension cable. The most important cause of lead fracture is the rotational movement of the lead-extension cable system. If we suspect lead fracture, we must check the impedance of the electrode and to evaluate the side effects of voltage. Finally, we must conduct a radiological screening.