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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Deep brain stimulation of the internal capsule or the nucleus accumbens in patients with obsessive-compulsive disorder: where to modulate?

Meeting Abstract

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  • Pablo Andrade - Klinik für Neurochirurgie, Uniklinik Köln, Köln, Deutschland
  • Juan Baldermann - Klinik für Psychiatrie, Uniklinik Köln, Köln, Deutschland
  • Sina Kohl - Klinik für Psychiatrie, Uniklinik Köln, Köln, Deutschland
  • Jens Kuhn - Klinik für Psychiatrie, Uniklinik Köln, Köln, Deutschland
  • Veerle Visser-Vandewalle - Klinik für Stereotaxie und Funktionelle Neurochirurgie, Uniklinik Köln, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 156

doi: 10.3205/17dgnc719, urn:nbn:de:0183-17dgnc7197

Published: June 9, 2017

© 2017 Andrade et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Several targets have been implicated in the study of the effects of deep brain stimulation (DBS) on obsessive-compulsive disorder (OCD) symptomatology. The most common targeted areas are the nucleus accumbens (Nacc), the internal capsule (IC), the ventral capsule/ventral striatum, and the subthalamic nucleus. To these days, there is still an ongoing debate about the best target for DBS in OCD patients. Furthermore, these structures cannot be considered as completely distinct targets as the NAcc is located immediately underneath the anterior limb of the IC and extends dorsolaterally into the ventral putamen and dorsomedially into the ventral caudate nucleus. Therefore, the differences between contact position may determine the clinical postoperative outcome. The objective of this study was to determine the association and differences between location of active contacts within the Nacc and the IC and clinical outcome at long-term follow up.

Methods: Twenty-three patients who underwent implantation of unilateral (N=3) or bilateral (N=20) electrodes for Nacc DBS were included in this study. OCD symptoms were measured with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scale before surgery and postoperatively for a long-term follow-up at different time points. For the lead location, preoperative MRI scans were fused with postoperative CT scans in order to assess the exact location of the active contacts.

Results: The mean postoperative follow-up was 18±7 months (range from 9-51 months). Mean stimulation parameters were 3.9±1V (range from 2.5-6.5V), 96±17µs (range from 90-150µs), 135±7Hz (range from 130-145Hz). Patients with active contacts in the Nacc showed an average improvement on the Y-BOCS of 47%, whereas patients with active contacts located in the IC showed an average improve of 32%. However, if the active contacts were located within a maximum distance of 1,5 mm of the transition between Nacc and the IC, the average improvement on the Y-BOCS scores was of 58%.

Conclusion: OCD patients with active electrodes for DBS in the transitional zone between Nacc and IC showed the best clinical outcome on the Y-BOCS scores at long-term follow-up compared to active electrodes located in Nacc or IC. Further studies will be required to determine if different regions of the cortico-striato-pallido-thalamo-cortical network are activated during stimulation of this region.