A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder
Abstract Deep brain stimulation (DBS) is a promising treatment for severe, treatment-resistant obsessive-compulsive disorder (OCD). Here, nine participants (four females, mean age 47.9 ± 10.7 years) were implanted with DBS electrodes bilaterally in the bed nucleus of the stria terminalis (BNST). Fol...
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doaj-f75448c380664579ad419258369ad7de2021-04-04T11:44:12ZengNature Publishing GroupTranslational Psychiatry2158-31882021-03-0111111710.1038/s41398-021-01307-9A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorderPhilip E. Mosley0François Windels1John Morris2Terry Coyne3Rodney Marsh4Andrea Giorni5Adith Mohan6Perminder Sachdev7Emily O’Leary8Mark Boschen9Pankaj Sah10Peter A. Silburn11Systems Neuroscience Group, QIMR Berghofer Medical Research InstituteQueensland Brain Institute, University of QueenslandQueensland Brain Institute, University of QueenslandQueensland Brain Institute, University of QueenslandNeurosciences Queensland, St Andrew’s War Memorial HospitalQueensland Brain Institute, University of QueenslandCentre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South WalesCentre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South WalesThe OCD ClinicSchool of Applied Psychology, Griffith UniversityQueensland Brain Institute, University of QueenslandNeurosciences Queensland, St Andrew’s War Memorial HospitalAbstract Deep brain stimulation (DBS) is a promising treatment for severe, treatment-resistant obsessive-compulsive disorder (OCD). Here, nine participants (four females, mean age 47.9 ± 10.7 years) were implanted with DBS electrodes bilaterally in the bed nucleus of the stria terminalis (BNST). Following a one-month postoperative recovery phase, participants entered a three-month randomised, double-blind, sham-controlled phase before a twelve-month period of open-label stimulation incorporating a course of cognitive behavioural therapy (CBT). The primary outcome measure was OCD symptoms as rated with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). In the blinded phase, there was a significant benefit of active stimulation over sham (p = 0.025, mean difference 4.9 points). After the open phase, the mean reduction in YBOCS was 16.6 ± 1.9 points (χ 2 (11) = 39.8, p = 3.8 × 10−5), with seven participants classified as responders. CBT resulted in an additive YBOCS reduction of 4.8 ± 3.9 points (p = 0.011). There were two serious adverse events related to the DBS device, the most severe of which was an infection during the open phase necessitating device explantation. There were no serious psychiatric adverse events related to stimulation. An analysis of the structural connectivity of each participant’s individualised stimulation field isolated right-hemispheric fibres associated with YBOCS reduction. These included subcortical tracts incorporating the amygdala, hippocampus and stria terminalis, in addition to cortical regions in the ventrolateral and ventromedial prefrontal cortex, parahippocampal, parietal and extrastriate visual cortex. In conclusion, this study provides further evidence supporting the efficacy and tolerability of DBS in the region of the BNST for individuals with otherwise treatment-refractory OCD and identifies a connectivity fingerprint associated with clinical benefit.https://doi.org/10.1038/s41398-021-01307-9 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Philip E. Mosley François Windels John Morris Terry Coyne Rodney Marsh Andrea Giorni Adith Mohan Perminder Sachdev Emily O’Leary Mark Boschen Pankaj Sah Peter A. Silburn |
spellingShingle |
Philip E. Mosley François Windels John Morris Terry Coyne Rodney Marsh Andrea Giorni Adith Mohan Perminder Sachdev Emily O’Leary Mark Boschen Pankaj Sah Peter A. Silburn A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder Translational Psychiatry |
author_facet |
Philip E. Mosley François Windels John Morris Terry Coyne Rodney Marsh Andrea Giorni Adith Mohan Perminder Sachdev Emily O’Leary Mark Boschen Pankaj Sah Peter A. Silburn |
author_sort |
Philip E. Mosley |
title |
A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder |
title_short |
A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder |
title_full |
A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder |
title_fullStr |
A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder |
title_full_unstemmed |
A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder |
title_sort |
randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder |
publisher |
Nature Publishing Group |
series |
Translational Psychiatry |
issn |
2158-3188 |
publishDate |
2021-03-01 |
description |
Abstract Deep brain stimulation (DBS) is a promising treatment for severe, treatment-resistant obsessive-compulsive disorder (OCD). Here, nine participants (four females, mean age 47.9 ± 10.7 years) were implanted with DBS electrodes bilaterally in the bed nucleus of the stria terminalis (BNST). Following a one-month postoperative recovery phase, participants entered a three-month randomised, double-blind, sham-controlled phase before a twelve-month period of open-label stimulation incorporating a course of cognitive behavioural therapy (CBT). The primary outcome measure was OCD symptoms as rated with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). In the blinded phase, there was a significant benefit of active stimulation over sham (p = 0.025, mean difference 4.9 points). After the open phase, the mean reduction in YBOCS was 16.6 ± 1.9 points (χ 2 (11) = 39.8, p = 3.8 × 10−5), with seven participants classified as responders. CBT resulted in an additive YBOCS reduction of 4.8 ± 3.9 points (p = 0.011). There were two serious adverse events related to the DBS device, the most severe of which was an infection during the open phase necessitating device explantation. There were no serious psychiatric adverse events related to stimulation. An analysis of the structural connectivity of each participant’s individualised stimulation field isolated right-hemispheric fibres associated with YBOCS reduction. These included subcortical tracts incorporating the amygdala, hippocampus and stria terminalis, in addition to cortical regions in the ventrolateral and ventromedial prefrontal cortex, parahippocampal, parietal and extrastriate visual cortex. In conclusion, this study provides further evidence supporting the efficacy and tolerability of DBS in the region of the BNST for individuals with otherwise treatment-refractory OCD and identifies a connectivity fingerprint associated with clinical benefit. |
url |
https://doi.org/10.1038/s41398-021-01307-9 |
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