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Stereotactic and Functional Neurosurgery pp 53–59Cite as

Active Stimulation Site of Nucleus Accumbens Deep Brain Stimulation in Obsessive–Compulsive Disorder Is Localized in the Ventral Internal Capsule

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Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 117))

Abstract

Obsessive–compulsive disorder (OCD) is a chronic psychiatric disorder characterized by persistent thoughts and repetitive ritualistic behaviours. Despite optimal cognitive–behavioral and pharmacological therapy, approximately 10 % of patients remain treatment-resistant. Deep brain stimulation (DBS) is being investigated as experimental therapy for treatment-refractory OCD. In the current study, we determined the relationship between anatomical location of active electrode contacts and clinical outcome in 16 OCD patients undergoing bilateral nucleus accumbens (NAc) DBS. We found that most patients actually do not receive active stimulation in the NAc but in the more laterally, anteriorly and dorsally located ventral part of the anterior limb of the internal capsule, ventral ALIC (vALIC). Our nine patients receiving bilateral vALIC DBS improved on average 73 % on their Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) scores, whereas the six patients with their centers of stimulation located otherwise improved on average only 42 %. We therefore propose bilateral vALIC as a promising new DBS target for patients with treatment-refractory OCD. Future studies employing a direct vALIC targeting approach in larger patient numbers are needed to test whether this proposal holds true.

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Conflict of Interest

The DBS devices used in the current patients were provided by Medtronic in the form of an unrestricted investigator-initiated research grant to Dr Denys and Dr Schuurman during the original study by Denys et al. [3]. The department of neurosurgery of the AMC has received an unrestricted grant for movement disorders research from Medtronic. Dr van den Munckhof has received travel grants from Medtronic. Dr Schuurman has received travel grants from Medtronic, and acts as independent advisor for Medtronic on educational matters. No other financial interest or potential conflicts are reported.

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Authors and Affiliations

  1. Department of Neurosurgery H2-238, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands

    Pepijn van den Munckhof, D. Andries Bosch & P. Richard Schuurman

  2. Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1005 AZ, Amsterdam, The Netherlands

    Mariska H. M. Mantione, Martijn Figee & Damiaan A. J. P. Denys

Authors
  1. Pepijn van den Munckhof
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  2. D. Andries Bosch
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  3. Mariska H. M. Mantione
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  4. Martijn Figee
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  5. Damiaan A. J. P. Denys
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  6. P. Richard Schuurman
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Corresponding author

Correspondence to Pepijn van den Munckhof .

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Editors and Affiliations

  1. , Neurosurgical Clinic, University Hospital Erlangen, Schwabachanlage 6, Erlangen, 91054, Germany

    Guido Nikkhah

  2. Department of Neurosurgery, Division of Stereotactic and Functional, University Medical Center Freiburg, Breisacher Straße 64, Freiburg, 79106, Germany

    Marcus Pinsker

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© 2013 Springer-Verlag Wien

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van den Munckhof, P., Bosch, D.A., Mantione, M.H.M., Figee, M., Denys, D.A.J.P., Schuurman, P.R. (2013). Active Stimulation Site of Nucleus Accumbens Deep Brain Stimulation in Obsessive–Compulsive Disorder Is Localized in the Ventral Internal Capsule. In: Nikkhah, G., Pinsker, M. (eds) Stereotactic and Functional Neurosurgery. Acta Neurochirurgica Supplement, vol 117. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1482-7_9

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  • DOI: https://doi.org/10.1007/978-3-7091-1482-7_9

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  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-1481-0

  • Online ISBN: 978-3-7091-1482-7

  • eBook Packages: MedicineMedicine (R0)

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