Clinical Outcome and Mechanisms of Deep Brain Stimulation for Obsessive-Compulsive Disorder

Maarten van Westen; Erik Rietveld; Martijn Figee; Damiaan Denys

doi:10.1007/s40473-015-0036-3

Clinical Outcome and Mechanisms of Deep Brain Stimulation for Obsessive-Compulsive Disorder

Maarten van Westen, Erik Rietveld, Martijn Figee, Damiaan Denys

Research output: Contribution to journal › Article › peer-review

36 Scopus citations

Abstract

Clinical outcome of deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) shows robust effects in terms of a mean Yale-Brown Obsessive-Compulsive Scale (YBOCS) reduction of 47.7 % and a mean response percentage (minimum 35 % YBOCS reduction) of 58.2 %. It appears that most patients regain a normal quality of life (QoL) after DBS. Reviewing the literature of the last 4 years, we argue that the mechanisms of action of DBS are a combination of excitatory and inhibitory as well as local and distal effects. Evidence from DBS animal models converges with human DBS EEG and imaging findings, in that DBS may be effective for OCD by reduction of hyperconnectivity between frontal and striatal areas. This is achieved through reduction of top-down-directed synchrony and reduction of frontal low-frequency oscillations. DBS appears to counteract striatal dysfunction through an increase in striatal dopamine and through improvement of reward processing. DBS affects anxiety levels through reduction of stress hormones and improvement of fear extinction.

Original language	English
Pages (from-to)	41-48
Number of pages	8
Journal	Current Behavioral Neuroscience Reports
Volume	2
Issue number	2
DOIs	https://doi.org/10.1007/s40473-015-0036-3
State	Published - 1 Jun 2015
Externally published	Yes

Keywords

Clinical outcome
Deep brain stimulation
Mechanisms of action
Obsessive-compulsive disorder
Quality of life

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10.1007/s40473-015-0036-3

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title = "Clinical Outcome and Mechanisms of Deep Brain Stimulation for Obsessive-Compulsive Disorder",

abstract = "Clinical outcome of deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) shows robust effects in terms of a mean Yale-Brown Obsessive-Compulsive Scale (YBOCS) reduction of 47.7 % and a mean response percentage (minimum 35 % YBOCS reduction) of 58.2 %. It appears that most patients regain a normal quality of life (QoL) after DBS. Reviewing the literature of the last 4 years, we argue that the mechanisms of action of DBS are a combination of excitatory and inhibitory as well as local and distal effects. Evidence from DBS animal models converges with human DBS EEG and imaging findings, in that DBS may be effective for OCD by reduction of hyperconnectivity between frontal and striatal areas. This is achieved through reduction of top-down-directed synchrony and reduction of frontal low-frequency oscillations. DBS appears to counteract striatal dysfunction through an increase in striatal dopamine and through improvement of reward processing. DBS affects anxiety levels through reduction of stress hormones and improvement of fear extinction.",

keywords = "Clinical outcome, Deep brain stimulation, Mechanisms of action, Obsessive-compulsive disorder, Quality of life",

author = "{van Westen}, Maarten and Erik Rietveld and Martijn Figee and Damiaan Denys",

note = "Funding Information: ER gratefully acknowledges the support he obtained from the Netherlands Organization for Scientific Research (NWO) in the form of a VIDI grant. ᅟ Damiaan Denys works as a consultant for Lundbeck and received honoraria from Medtronic and Lundbeck, royalties from UpToDate, and travel accommodations from Medtronic and Lundbeck. Martijn Figee, Erik Rietveld, and Maarten van Westen have no relevant disclosures to report. This article does not contain any studies with human or animal subjects performed by the author. Funding Information: ER gratefully acknowledges the support he obtained from the Netherlands Organization for Scientific Research (NWO) in the form of a VIDI grant. Publisher Copyright: {\textcopyright} 2015, The Author(s).",

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doi = "10.1007/s40473-015-0036-3",

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N1 - Funding Information: ER gratefully acknowledges the support he obtained from the Netherlands Organization for Scientific Research (NWO) in the form of a VIDI grant. ᅟ Damiaan Denys works as a consultant for Lundbeck and received honoraria from Medtronic and Lundbeck, royalties from UpToDate, and travel accommodations from Medtronic and Lundbeck. Martijn Figee, Erik Rietveld, and Maarten van Westen have no relevant disclosures to report. This article does not contain any studies with human or animal subjects performed by the author. Funding Information: ER gratefully acknowledges the support he obtained from the Netherlands Organization for Scientific Research (NWO) in the form of a VIDI grant. Publisher Copyright: © 2015, The Author(s).

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N2 - Clinical outcome of deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) shows robust effects in terms of a mean Yale-Brown Obsessive-Compulsive Scale (YBOCS) reduction of 47.7 % and a mean response percentage (minimum 35 % YBOCS reduction) of 58.2 %. It appears that most patients regain a normal quality of life (QoL) after DBS. Reviewing the literature of the last 4 years, we argue that the mechanisms of action of DBS are a combination of excitatory and inhibitory as well as local and distal effects. Evidence from DBS animal models converges with human DBS EEG and imaging findings, in that DBS may be effective for OCD by reduction of hyperconnectivity between frontal and striatal areas. This is achieved through reduction of top-down-directed synchrony and reduction of frontal low-frequency oscillations. DBS appears to counteract striatal dysfunction through an increase in striatal dopamine and through improvement of reward processing. DBS affects anxiety levels through reduction of stress hormones and improvement of fear extinction.

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Clinical Outcome and Mechanisms of Deep Brain Stimulation for Obsessive-Compulsive Disorder

Abstract

Keywords

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