Six-Nine Year Follow-Up of Deep Brain Stimulation for Obsessive-Compulsive Disorder.

Autor: Fayad SM; Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, United States of America., Guzick AG; Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, United States of America.; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America., Reid AM; Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, United States of America.; Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America.; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America., Mason DM; Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, United States of America., Bertone A; Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, United States of America., Foote KD; Department of Neurosurgery, College of Medicine, University of Florida, Gainesville, Florida, United States of America., Okun MS; Department of Neurology, College of Medicine, University of Florida, Gainesville, Florida, United States of America., Goodman WK; Department of Psychiatry, Mount Sinai School of Medicine, New York, New York, United States of America., Ward HE; Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2016 Dec 08; Vol. 11 (12), pp. e0167875. Date of Electronic Publication: 2016 Dec 08 (Print Publication: 2016).
DOI: 10.1371/journal.pone.0167875
Abstrakt: Objective: Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) region has shown promise as a neurosurgical intervention for adults with severe treatment-refractory obsessive-compulsive disorder (OCD). Pilot studies have revealed improvement in obsessive-compulsive symptoms and secondary outcomes following DBS. We sought to establish the long-term safety and effectiveness of DBS of the VC/VS for adults with OCD.
Materials and Methods: A long term follow-up study (73-112 months) was conducted on the six patients who were enrolled in the original National Institute of Mental Health pilot study of DBS for OCD. Qualitative and quantitative data were collected.
Results: Reduction in OCD symptoms mirrored the one-year follow-up data. The same four participants who were treatment responders after one year of treatment showed a consistent OCD response (greater than 35% reduction in Yale Brown Obsessive Compulsive Scale (YBOCS)). Another subject, classified as a non-responder, achieved a 26% reduction in YBOCS score at long term follow-up. The only patient who did not achieve a 25% or greater reduction in YBOCS was no longer receiving active DBS treatment. Secondary outcomes generally matched the one-year follow-up with the exception of depressive symptoms, which significantly increased over the follow-up period. Qualitative feedback indicated that DBS was well tolerated by the subjects.
Discussion: These data indicate that DBS was safe and conferred a long-term benefit in reduction of obsessive-compulsive symptoms. DBS of the VC/VS region did not reveal a sustained response for comorbid depressive symptoms in patients with a primary diagnosis of OCD.
Competing Interests: Dr. Sarah Fayad is on the scientific advisory board of Acadia Pharmaceuticals. Mr. Andrew Guzick, Mr. Adam Reid, Mrs. Dana Mason, Ms. Agustina Bertone, Dr. Kelly Foote and Dr. Herbert Ward have nothing to disclose. Dr. Michael Okun serves as a consultant for the National Parkinson Foundation, and has received research grants from NIH, NPF, the Michael J. Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association, and the UF Foundation. Dr. Okun has previously received honoraria, but in the past >60 months has received no support from industry. Dr. Okun has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients, and Cambridge (movement disorders books). Dr. Okun is an associate editor for New England Journal of Medicine Journal Watch Neurology. Dr. Okun has participated in CME and educational activities on movement disorders (in the last 36) months sponsored by PeerView, Prime, Quantia, Henry Stewart, and by Vanderbilt University. The institution and not Dr. Okun receives grants from Medtronic, Abbvie, and ANS/St. Jude, and the PI has no financial interest in these grants. Dr. Okun has participated as a site PI and/or co-I for several NIH, foundation, and industry sponsored trials over the years but has not received honoraria. Dr. Wayne Goodman has participated as a site PI and/or co-I for several NIH sponsored trials, including the R21 that funded this pilot DBS trial. Related to this grant, he received travel support and a donation of DBS devices from Medtronic. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Databáze: MEDLINE
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