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

TLDR

Obsessive‑compulsive disorder is an anxiety disorder marked by intrusive thoughts and repetitive behaviors, and up to 30 % of patients remain refractory to conventional treatments, prompting consideration of deep brain stimulation of the anterior limb of the internal capsule. This study examined whether deep brain stimulation of the ventral caudate nucleus could alleviate symptoms in a patient with intractable severe OCD and comorbid major depression. The authors assessed symptom severity with Y‑BOCS, HDRS, HARS, and GAF scales, and evaluated neuropsychological function through a battery of memory and executive tests. Ventral caudate DBS produced rapid remission of depression and anxiety by six months, delayed OCD remission after 12–15 months, improved GAF scores, and showed no neuropsychological decline, indicating it as a promising treatment for refractory OCD and depression.

Abstract

✓ 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.