Sustained Recovery in a Treatment-Refractory Obsessive–Compulsive Disorder Patient After Deep Brain Stimulation Battery Failure
Obsessive-compulsive disorder (OCD) is a widespread chronic neuropsychiatric disorder characterized by recurrent intrusive thoughts, images, or urges (obsessions) that typically cause anxiety or distress. Even when optimal treatment is provided, 10% of patients remain severely affected chronically....
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Frontiers Media S.A.
2020-11-01
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Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2020.572059/full |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Redwan Maatoug Antoni Valero-Cabré Antoni Valero-Cabré Antoni Valero-Cabré Antoni Valero-Cabré Philibert Duriez Philibert Duriez Bertrand Saudreau Sara Fernández-Vidal Sara Fernández-Vidal Sara Fernández-Vidal Sara Fernández-Vidal Carine Karachi Carine Karachi Carine Karachi Carine Karachi Bruno Millet |
spellingShingle |
Redwan Maatoug Antoni Valero-Cabré Antoni Valero-Cabré Antoni Valero-Cabré Antoni Valero-Cabré Philibert Duriez Philibert Duriez Bertrand Saudreau Sara Fernández-Vidal Sara Fernández-Vidal Sara Fernández-Vidal Sara Fernández-Vidal Carine Karachi Carine Karachi Carine Karachi Carine Karachi Bruno Millet Sustained Recovery in a Treatment-Refractory Obsessive–Compulsive Disorder Patient After Deep Brain Stimulation Battery Failure Frontiers in Psychiatry obsessive compulsive disorder deep brain stimulation treatment refractory stimulation techniques battery failure case-report |
author_facet |
Redwan Maatoug Antoni Valero-Cabré Antoni Valero-Cabré Antoni Valero-Cabré Antoni Valero-Cabré Philibert Duriez Philibert Duriez Bertrand Saudreau Sara Fernández-Vidal Sara Fernández-Vidal Sara Fernández-Vidal Sara Fernández-Vidal Carine Karachi Carine Karachi Carine Karachi Carine Karachi Bruno Millet |
author_sort |
Redwan Maatoug |
title |
Sustained Recovery in a Treatment-Refractory Obsessive–Compulsive Disorder Patient After Deep Brain Stimulation Battery Failure |
title_short |
Sustained Recovery in a Treatment-Refractory Obsessive–Compulsive Disorder Patient After Deep Brain Stimulation Battery Failure |
title_full |
Sustained Recovery in a Treatment-Refractory Obsessive–Compulsive Disorder Patient After Deep Brain Stimulation Battery Failure |
title_fullStr |
Sustained Recovery in a Treatment-Refractory Obsessive–Compulsive Disorder Patient After Deep Brain Stimulation Battery Failure |
title_full_unstemmed |
Sustained Recovery in a Treatment-Refractory Obsessive–Compulsive Disorder Patient After Deep Brain Stimulation Battery Failure |
title_sort |
sustained recovery in a treatment-refractory obsessive–compulsive disorder patient after deep brain stimulation battery failure |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Psychiatry |
issn |
1664-0640 |
publishDate |
2020-11-01 |
description |
Obsessive-compulsive disorder (OCD) is a widespread chronic neuropsychiatric disorder characterized by recurrent intrusive thoughts, images, or urges (obsessions) that typically cause anxiety or distress. Even when optimal treatment is provided, 10% of patients remain severely affected chronically. In some countries, deep brain stimulation (DBS) is an approved and effective therapy for patients suffering from treatment-resistant OCD. Hereafter, we report the case of a middle-aged man with a long history of treatment-resistant OCD spanning nearly a decade with Yale–Brown Obsessive Compulsive Scale (Y-BOCS) scores oscillating between 21 and 28. The patient underwent bilateral implantation of ventral striatum/ventral capsule DBS leads attached to a battery-operated implanted pulse generator. After a 3-month postimplantation period, the DBS protocol started. Three months after the onset of DBS treatment, the patient's Y-BOCS score had dropped to 3, and he became steadily asymptomatic. However, inadvertently, at this time, it was found out that the implanted pulse generator battery had discharged completely, interrupting brain stimulation. The medical team carried on with the original therapeutic and evaluation plan in the absence of active DBS current. After 12 additional months under off-DBS, the patient remained at a Y-BOCS score of 7 and asymptomatic. To our knowledge, this is the first report that provides an opportunity to discuss four different hypotheses of long-term recovery induced by DBS in a treatment-refractory OCD patient, notably: (1) A placebo effect; (2) Paradoxical improvements induced by micro-lesions generated by DBS probe implantation procedures; (3) Unexpected late spontaneous improvements; (4) Recovery driven by a combination of active DBS-induction, the effects of medication, and DBS-placebo effects. |
topic |
obsessive compulsive disorder deep brain stimulation treatment refractory stimulation techniques battery failure case-report |
url |
https://www.frontiersin.org/articles/10.3389/fpsyt.2020.572059/full |
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doaj-800e5db5feff48788ec3030ab7e654172020-11-25T04:09:57ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402020-11-011110.3389/fpsyt.2020.572059572059Sustained Recovery in a Treatment-Refractory Obsessive–Compulsive Disorder Patient After Deep Brain Stimulation Battery FailureRedwan Maatoug0Antoni Valero-Cabré1Antoni Valero-Cabré2Antoni Valero-Cabré3Antoni Valero-Cabré4Philibert Duriez5Philibert Duriez6Bertrand Saudreau7Sara Fernández-Vidal8Sara Fernández-Vidal9Sara Fernández-Vidal10Sara Fernández-Vidal11Carine Karachi12Carine Karachi13Carine Karachi14Carine Karachi15Bruno Millet16Sorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, Paris, FranceGroupe de Dynamiques Cérébrales, Plasticité et Rééducation and Frontlab Team, Institut du Cerveau (ICM), INSERM 1127, CNRS, UMR 7225 and Sorbonne Université (SO), Paris, FranceInstitut du Cerveau et de la Moelle Epinière (ICM), CNRS UMR 7225, INSERM U 1127, Sorbonne Université, Paris, FranceLaboratory for Cerebral Dynamics Plasticity and Rehabilitation, Boston University, School of Medicine, Boston, MA, United StatesCognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, SpainInstitute of Psychiatry and Neurosciences of Paris, Unité Mixte de Recherche en Santé (UMRS) 1266 Institut National de la Santé et de la Recherche Médicale (INSERM), University Paris Descartes, Paris, FranceClinique des Maladies Mentales et de l'Encéphale, Groupement Hospitalier Universitaire (GHU) Paris Psychiatry and Neuroscience, Sainte-Anne Hospital, Paris, FranceSorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, Paris, FranceUniversité Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau (CRICM), UMR-S975, Paris, FranceINSERM, U975, Paris, France0CNRS, UMR 7225, CR-ICM, Paris, France1Centre de Neuroimagerie de Recherche de l'Institut du Cerveau (CENIR ICM), Paris, FranceUniversité Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau (CRICM), UMR-S975, Paris, FranceINSERM, U975, Paris, France0CNRS, UMR 7225, CR-ICM, Paris, France2Neurosurgery Department, APHP, Hôpitaux Universitaires Pitié-Salpêtrière/Charles Foix, Paris, FranceSorbonne Université, AP-HP, Service de psychiatrie adulte de la Pitié-Salpêtrière, Institut du Cerveau, ICM, Paris, FranceObsessive-compulsive disorder (OCD) is a widespread chronic neuropsychiatric disorder characterized by recurrent intrusive thoughts, images, or urges (obsessions) that typically cause anxiety or distress. Even when optimal treatment is provided, 10% of patients remain severely affected chronically. In some countries, deep brain stimulation (DBS) is an approved and effective therapy for patients suffering from treatment-resistant OCD. Hereafter, we report the case of a middle-aged man with a long history of treatment-resistant OCD spanning nearly a decade with Yale–Brown Obsessive Compulsive Scale (Y-BOCS) scores oscillating between 21 and 28. The patient underwent bilateral implantation of ventral striatum/ventral capsule DBS leads attached to a battery-operated implanted pulse generator. After a 3-month postimplantation period, the DBS protocol started. Three months after the onset of DBS treatment, the patient's Y-BOCS score had dropped to 3, and he became steadily asymptomatic. However, inadvertently, at this time, it was found out that the implanted pulse generator battery had discharged completely, interrupting brain stimulation. The medical team carried on with the original therapeutic and evaluation plan in the absence of active DBS current. After 12 additional months under off-DBS, the patient remained at a Y-BOCS score of 7 and asymptomatic. To our knowledge, this is the first report that provides an opportunity to discuss four different hypotheses of long-term recovery induced by DBS in a treatment-refractory OCD patient, notably: (1) A placebo effect; (2) Paradoxical improvements induced by micro-lesions generated by DBS probe implantation procedures; (3) Unexpected late spontaneous improvements; (4) Recovery driven by a combination of active DBS-induction, the effects of medication, and DBS-placebo effects.https://www.frontiersin.org/articles/10.3389/fpsyt.2020.572059/fullobsessive compulsive disorderdeep brain stimulationtreatment refractorystimulation techniquesbattery failurecase-report |