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BMC Psychiatry
Published in: BMC Psychiatry 1/2016

Open Access 01-12-2016 | Case report

Removing and reimplanting deep brain stimulation therapy devices in resistant OCD (when the patient does not respond): case report

Authors: Eva Real, Gerard Plans, Pino Alonso, Marco A. Aparicio, Cinto Segalàs, Narcís Cardoner, Carles Soriano-Mas, Clara López-Solà, José M. Menchón

Published in: BMC Psychiatry | Issue 1/2016

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Abstract

Background

Deep brain stimulation (DBS) is emerging as a promising tool in the treatment of refractory obsessive-compulsive disorder (OCD) but the search for the best target still continues. This issue is especially relevant when particularly resistant profiles are observed in some patients, which have been ascribed to individual responses to DBS according to differential patterns of connectivity. As patients have been implanted, new dilemmas have emerged, such as what to do when the patient does not respond to surgery.

Case presentation

Here we describe a 22-year-old male with extremely severe OCD who did not respond to treatment with DBS in the nucleus accumbens, but who did respond after explanting and reimplanting leads targeting the ventral capsule-ventral striatum region. Information regarding the position of the electrodes for both surgeries is provided and possible brain structures affected during stimulation are reviewed. To our knowledge this case is the first in the literature reporting the removal and reimplantation of DBS leads for therapeutical benefits in a patient affected by a mental disorder.

Conclusion

The capability for explantation and reimplantation of leads should be considered as part of the DBS therapy reversibility profile in resistant mental disorders, as it allows application in cases of non-response to the first surgery.
Literature
1.
Rabins P, Appleby BS, Brandt J, DeLong MR, Dunn LB, Gabriels L, et al. Scientific and ethical issues related to deep brain stimulation for disorders of mood, behavior, and thought. Arch Gen Psychiatry. 2009;66:931–7.PubMedCentralCrossRefPubMed
2.
Greenberg BD, Rezai AR. Mechanisms and the current state of deep brain stimulation in neuropsychiatry. CNS Spectr. 2003;8:522–6.PubMed
3.
Mindus P, Rasmussen SA, Lindquist C. Neurosurgical treatment for refractory obsessive-compulsive disorder: implications for understanding frontal lobe function. J Neuropsychiatry Clin Neurosci. 1994;6:467–77.CrossRefPubMed
4.
Ruck C, Andreewitch S, Flyckt K, Edman G, Nyman H, Meyerson BA, et al. Capsulotomy for refractory anxiety disorders: long-term follow-up of 26 patients. Am J Psychiatry. 2003;160:513–21.CrossRefPubMed
5.
Gorgulho A, Juillard C, Uslan DZ, Tajik K, Aurasteh P, Behnke E, et al. Infection following deep brain stimulator implantation performed in the conventional versus magnetic resonance imaging-equipped operating room. J Neurosurg. 2009;110:239–46.CrossRefPubMed
6.
Ramirez-Zamora A, Levine D, Sommer DB, Dalfino J, Novak P, Pilitsis JG. Intraparenchymal cyst development after deep brain stimulator placement. Stereotact Funct Neurosurg. 2013;91:338–41.CrossRefPubMed
7.
Tolleson C, Stroh J, Ehrenfeld J, Neimat J, Konrad P, Phibbs F. The factors involved in deep brain stimulation infection: a large case series. Stereotact Funct Neurosurg. 2014;92:227–33.CrossRefPubMed
8.
Kuhn J, Lenartz D, Mai JK, Huff W, Lee SH, Koulousakis A, et al. Deep brain stimulation of the nucleus accumbens and the internal capsule in therapeutically refractory Tourette-syndrome. J Neurol. 2007;254:963–5.CrossRefPubMed
9.
Sturm V, Lenartz D, Koulousakis A, Treuer H, Herholz K, Klein JC, et al. The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsive- and anxiety-disorders. J Chem Neuroanat. 2003;26:293–9.CrossRefPubMed
10.
Mai JK, Paxinos G, and Voss T, Atlas of the Human Brain. 3rd edition: Academic Press ed. 2008: Elsevier Inc.
11.
Greenberg BD, Gabriels LA, Malone Jr DA, Rezai AR, Friehs GM, Okun MS, et al. Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry. 2010;15:64–79.PubMedCentralCrossRefPubMed
12.
Nuttin B, Cosyns P, Demeulemeester H, Gybels J, Meyerson B. Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet. 1999;354:1526.CrossRefPubMed
13.
Huff W, Lenartz D, Schormann M, Lee SH, Kuhn J, Koulousakis A, et al. Unilateral deep brain stimulation of the nucleus accumbens in patients with treatment-resistant obsessive-compulsive disorder: Outcomes after one year. Clin Neurol Neurosurg. 2010;112:137–43.CrossRefPubMed
14.
Aouizerate B, Cuny E, Martin-Guehl C, Guehl D, Amieva H, Benazzouz A, et al. Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive-compulsive disorder and major depression. Case report. J Neurosurg. 2004;101:682–6.CrossRefPubMed
15.
Jimenez F, Nicolini H, Lozano AM, Piedimonte F, Salin R, Velasco F. Electrical Stimulation of the Inferior Thalamic Peduncle in the Treatment of Major Depression and Obsessive Compulsive Disorders. World Neurosurg. 2013;80(3–4):17–25
16.
Mallet L, Polosan M, Jaafari N, Baup N, Welter ML, Fontaine D, et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med. 2008;359:2121–34.CrossRefPubMed
17.
Alonso P, Cuadras D, Gabriels L, Denys D, Goodman W, Greenberg BD, et al. Deep brain stimulation for obsessive-compulsive disorder: a meta-analysis of treatment outcome and predictors of response. PLoS One. 2015;10, e0133591.PubMedCentralCrossRefPubMed
18.
van Westen M, Rietveld E, Figee M, Denys D. Clinical outcome and mechanisms of deep brain stimulation for obsessive-compulsive disorder. Curr Behav Neurosci Rep. 2015;2:41–8.PubMedCentralCrossRefPubMed
19.
Duvarci S, Bauer EP, Pare D. The bed nucleus of the stria terminalis mediates inter-individual variations in anxiety and fear. J Neurosci. 2009;29:10357–61.PubMedCentralCrossRefPubMed
20.
Coenen VA, Panksepp J, Hurwitz TA, Urbach H, Madler B. Human Medial Forebrain Bundle (MFB) and Anterior Thalamic Radiation (ATR): Imaging of Two Major Subcortical Pathways and the Dynamic Balance of Opposite Affects in Understanding Depression. J Neuropsychiatry Clin Neurosci. 2012;24:223–36.CrossRefPubMed
21.
Lipsman N, Neimat JS, Lozano AM. Deep brain stimulation for treatment-refractory obsessive-compulsive disorder: the search for a valid target. Neurosurgery. 2007;61:1–11. discussion 11–3.CrossRefPubMed
22.
Denys D, Mantione M, Figee M, van den Munckhof P, Koerselman F, Westenberg H, et al. Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Arch Gen Psychiatry. 2010;67:1061–8.CrossRefPubMed
23.
Greenberg BD, Malone DA, Friehs GM, Rezai AR, Kubu CS, Malloy PF, et al. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology. 2006;31:2384–93.CrossRefPubMed
24.
Gutman DA, Holtzheimer PE, Behrens TE, Johansen-Berg H, Mayberg HS. A tractography analysis of two deep brain stimulation white matter targets for depression. Biol Psychiatry. 2009;65:276–82.PubMedCentralCrossRefPubMed
25.
Servello D, Sassi M, Brambilla A, Porta M, Haq I, Foote KD, et al. De novo and rescue DBS leads for refractory Tourette syndrome patients with severe comorbid OCD: a multiple case report. J Neurol. 2009;256:1533–9.CrossRefPubMed
26.
van den Munckhof P, Bosch DA, Mantione MH, Figee M, Denys DA, Schuurman PR. Active stimulation site of nucleus accumbens deep brain stimulation in obsessive-compulsive disorder is localized in the ventral internal capsule. Acta Neurochir Suppl. 2013;117:53–9.PubMed
27.
Bourne SK, Eckhardt CA, Sheth SA, Eskandar EN. Mechanisms of deep brain stimulation for obsessive compulsive disorder: effects upon cells and circuits. Front Integr Neurosci. 2012;6:29.PubMedCentralCrossRefPubMed
28.
Andrade P, Fernandez-Guasti A, Carrillo-Ruiz JD, Ulloa RE, Ramirez Y, Reyes R, et al. Effects of bilateral lesions in thalamic reticular nucleus and orbitofrontal cortex in a T-maze perseverative model produced by 8-OH-DPAT in rats. Behav Brain Res. 2009;203:108–12.CrossRefPubMed
29.
Jimenez-Ponce F, Velasco-Campos F, Castro-Farfan G, Nicolini H, Velasco AL, Salin-Pascual R, et al. Preliminary study in patients with obsessive-compulsive disorder treated with electrical stimulation in the inferior thalamic peduncle. Neurosurgery. 2009;65:203–9. discussion 209.CrossRefPubMed
30.
Aouizerate B, Cuny E, Rotge JY, Martin-Guehl C, Doumy O, Benazzouz A, et al. Is deep brain stimulation able to make antidepressants effective in resistant obsessive-compulsive disorder? Biol Psychiatry. 2012;71:e43–4.CrossRefPubMed
Metadata
Title
Removing and reimplanting deep brain stimulation therapy devices in resistant OCD (when the patient does not respond): case report
Authors
Eva Real
Gerard Plans
Pino Alonso
Marco A. Aparicio
Cinto Segalàs
Narcís Cardoner
Carles Soriano-Mas
Clara López-Solà
José M. Menchón
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-016-0730-z

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