Background

Deep brain stimulation (DBS) is an effective intervention for patients with severe treatment-refractory obsessive-compulsive disorder (OCD). Our aim was to examine long-term effectiveness and tolerability of DBS and its impact on functioning and well-being.

Methods

Fifty patients with severe treatment-refractory OCD received DBS of the ventral part of the anterior limb of the internal capsule and were followed for at least 3 years following implantation (mean 6.8 ± 3 years). Primary effectiveness was assessed by change in Yale-Brown Obsessive Compulsive Scale scores. Secondary effectiveness measures included Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, World Health Organization Quality of Life Scale–Brief Version, Global Assessment of Functioning, and a scale assessing functioning in work, family, and social life. Adverse effects of DBS were examined with a structured interview (n = 38).

Results

At long-term follow-up, OCD symptoms decreased by 39% (p < .001), and half of the patients were responders (≥35% decrease of Yale-Brown Obsessive Compulsive Scale score). Anxiety and depressive symptoms decreased significantly, with reductions of 48% and 50%, respectively. The World Health Organization Quality of Life Scale–Brief Version general score improved significantly, as did 3 of 4 subdomains. Both clinician- and patient-rated functioning improved substantially (p < .001). The unemployment rate decreased from 78% at baseline to 58% at last follow-up (z = −1.90, p = .058), and 21 patients stopped or decreased psychotropic medication (z = −2.887, p = .004). Long-term adverse effects included cognitive complaints and fatigue. Serious adverse events included 1 suicide attempt, related to comorbid depression.

Conclusions

Our results provide evidence that DBS of the ventral part of the anterior limb of the internal capsule is effective and tolerable for treatment-refractory OCD in the long term and improves functioning and overall well-being.

中文翻译：

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50 例难治性强迫症患者内囊前肢腹侧深部脑刺激的长期结果

背景

脑深部电刺激 (DBS) 是治疗严重难治性强迫症 (OCD) 患者的有效干预措施。我们的目标是检查 DBS 的长期有效性和耐受性及其对功能和福祉的影响。

方法

50 名重度难治性强迫症患者接受了内囊前肢腹侧 DBS，并在植入后至少随访 3 年（平均 6.8 ± 3 年）。通过耶鲁-布朗强迫症量表分数的变化评估主要有效性。次要有效性测量包括汉密尔顿焦虑量表、汉密尔顿抑郁量表、世界卫生组织生活质量量表 - 简要版、全球功能评估以及评估工作、家庭和社会生活功能的量表。DBS 的副作用通过结构化访谈进行了检查 ( n  = 38)。

结果

在长期随访中，OCD 症状减少了 39% ( p < .001)，一半的患者是有反应的（耶鲁-布朗强迫症量表评分减少≥35%）。焦虑和抑郁症状显着减少，分别减少了 48% 和 50%。世界卫生组织生活质量量表 - 简要版的总分显着提高，4 个子域中的 3 个也是如此。临床医生和患者评定的功能均显着改善 ( p < .001)。失业率从基线时的 78% 下降到最后一次随访时的 58% ( z  = -1.90, p  = .058)，21 名患者停止或减少精神药物治疗 ( z  = -2.887, p = .004）。长期不良反应包括认知不适和疲劳。严重的不良事件包括 1 次与合并抑郁症相关的自杀企图。

结论

我们的结果提供证据表明，内囊前肢腹侧的 DBS 对长期治疗难治性强迫症有效且可耐受，并改善功能和整体健康。