Clinical Outcome and Mechanisms of Deep Brain Stimulation for Obsessive-Compulsive Disorder

Maarten van Westen, Erik Rietveld, Martijn Figee, D. Denys

Research output: Contribution to journal/periodicalArticleScientificpeer-review

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Abstract

Clinical outcome of deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) shows robust effects in terms of a mean Yale-Brown Obsessive-Compulsive Scale (YBOCS) reduction of 47.7 % and a mean response percentage (minimum 35 % YBOCS reduction) of 58.2 %. It appears that most patients regain a normal quality of life (QoL) after DBS. Reviewing the literature of the last 4 years, we argue that the mechanisms of action of DBS are a combination of excitatory and inhibitory as well as local and distal effects. Evidence from DBS animal models converges with human DBS EEG and imaging findings, in that DBS may be effective for OCD by reduction of hyperconnectivity between frontal and striatal areas. This is achieved through reduction of top-down-directed synchrony and reduction of frontal low-frequency oscillations. DBS appears to counteract striatal dysfunction through an increase in striatal dopamine and through improvement of reward processing. DBS affects anxiety levels through reduction of stress hormones and improvement of fear extinction.

Original languageEnglish
Pages (from-to)41-48
Number of pages8
JournalCurrent behavioral neuroscience reports
Volume2
Issue number2
DOIs
Publication statusPublished - 01 Sep 2015

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