Publication Date
10-28-2024
Journal
Journal of Neurosurgery: Case Lessons
DOI
10.3171/CASE24289
PMID
39467322
PMCID
PMC11525764
PubMedCentral® Posted Date
10-28-2024
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
capsulotomy, case series, DBS, deep brain stimulation, obsessive-compulsive disorder, OCD
Abstract
BACKGROUND: Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by recurrent, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) performed to relieve distress related to the obsessions. For patients with severe illness refractory to first-line pharmacotherapy and psychotherapy, neurosurgical treatments such as deep brain stimulation (DBS) and stereotactic lesioning are an option. The choice between DBS and lesioning is often driven by patient preference, but these options are not mutually exclusive. Here, the authors highlight the success of one surgical therapy (DBS) after the failure of another (lesioning).
OBSERVATIONS: Two patients with severe, treatment-refractory OCD underwent DBS lead implantation targeting the ventral capsule/ventral striatum after they did not attain any worthwhile benefit from a previous anterior capsulotomy. Both patients showed significant improvement (≥ 35% reduction in Yale-Brown Obsessive-Compulsive Scale [YBOCS] score) of their OCD symptoms at the long-term follow-up after DBS. One patient experienced a 37% reduction in symptom severity as measured by the YBOCS, and the other patient experienced a 47% reduction.
LESSONS: DBS and lesioning procedures are both effective surgical options for patients with intractable OCD. In these cases, the authors demonstrate that DBS can be utilized even after a lesioning procedure in nominally the same target (ventral portion of the anterior limb of the internal capsule).https://thejns.org/doi/10.3171/CASE24289