Deep brain stimulation sites for OCD target distinct symptoms

Two DBS sites equally reduced OCD symptoms but improved distinct symptoms, according to a study in Biological Psychiatry


Philadelphia, March 7, 2019

Deep brain stimulation (DBS) reduces symptoms of severe obsessive–compulsive disorder (OCD) during stimulation of either the ventral capsule (VC) or anteromedial subthalamic nucleus (amSTN), according to a study in Biological Psychiatry. DBS of the regions reduced OCD symptoms to a similar extent, but produced distinct effects on specific symptoms—VC stimulation drastically improved mood, whereas amSTN stimulation in the same patients improved cognitive flexibility. The findings suggest that both regions are effective DBS sites for treating OCD, and that unique brain networks targeted in each region underlie specific symptoms of the disorder.

“This is the first study to compare directly the effects of DBS at two brain sites and has discovered important information about the brain changes in OCD responsible for obsessions and compulsions, depressed mood and cognitive inflexibility and how they might be alleviated,” said senior author Eileen Joyce, PhD, The Institute of Neurology, University College London, London, UK.

Using tractography to map the brain regions that were activated by DBS, Dr. Joyce and colleagues found that the different effects of VC and amSTN stimulation appeared to arise from DBS modulation of different brain networks. This finding provides clues as to the roles that those specific brain regions play in OCD, and has potentially important implications for treatment.

“The notion that particular OCD symptom clusters might particularly benefit from stimulation of distinct brain sites raises the possibility of bringing a precision medicine approach to deep brain stimulation,” said John Krystal, MD, Editor of Biological Psychiatry. “It also raises the question of whether multiple brain stimulation sites might be required to produce the broadest profile of efficacy,” he added. However, in the study, combined DBS of both sites did not produce substantially greater effects than either of the sites individually.

“Deep brain stimulation is an emerging treatment for a small number of individuals with extremely severe OCD whose condition has not responded to multiple courses of currently available treatments such as medication or cognitive behavioral therapy,” said Dr. Joyce. Cognitive behavioral therapy is an effective treatment for many people with OCD, but when combined with DBS in the study, it did not further enhance the symptom improvements produced by DBS.

For people with severe OCD whose symptoms don’t improve with the standard treatment methods, the findings show that DBS of VC or amSTN are equally effective and have unique effects for specific symptoms.

The study was supported by UK Medical Research Council and The Wellcome Trust.

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Notes for editors
The article is "A Randomized Trial Directly Comparing Ventral Capsule and Anteromedial Subthalamic Nucleus Stimulation in Obsessive-Compulsive Disorder: Clinical and Imaging Evidence for Dissociable Effects," by Himanshu Tyagi, Annemieke M. Apergis-Schoute, Harith Akram, Tom Foltynie, Patricia Limousin, Lynne M. Drummond, Naomi A. Fineberg, Keith Matthews, Marjan Jahanshahi, Trevor W. Robbins, Barbara J. Sahakian, Ludvic Zrinzo, Marwan Hariz, and Eileen M. Joyce (https://doi.org/10.1016/j.biopsych.2019.01.017). It appears in Biological Psychiatry, published by Elsevier.

This study is published open access and can be downloaded by following the DOI link above.

Journalists wishing to interview the authors may contact Eileen Joyce, PhD, at e.joyce@ucl.ac.uk or +44 203 448 3524.

The authors’ affiliations and disclosures of financial and conflicts of interests are available in the article.

John H. Krystal, MD, is Chairman of the Department of Psychiatry at the Yale University School of Medicine, Chief of Psychiatry at Yale-New Haven Hospital, and a research psychiatrist at the VA Connecticut Healthcare System. His disclosures of financial and conflicts of interests are available here.

About Biological Psychiatry
Biological Psychiatry is the official journal of the Society of Biological Psychiatry, whose purpose is to promote excellence in scientific research and education in fields that investigate the nature, causes, mechanisms and treatments of disorders of thought, emotion, or behavior. In accord with this mission, this peer-reviewed, rapid-publication, international journal publishes both basic and clinical contributions from all disciplines and research areas relevant to the pathophysiology and treatment of major psychiatric disorders.

The journal publishes novel results of original research which represent an important new lead or significant impact on the field, particularly those addressing genetic and environmental risk factors, neural circuitry and neurochemistry, and important new therapeutic approaches. Reviews and commentaries that focus on topics of current research and interest are also encouraged.

Biological Psychiatry is one of the most selective and highly cited journals in the field of psychiatric neuroscience. It is ranked 6th out of 142 Psychiatry titles and 9th out of 261 Neurosciences titles in the Journal Citations Reports® published by Clarivate Analytics. The 2017 Impact Factor score for Biological Psychiatry is 11.982. www.sobp.org/journal

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