Combined bilateral anterior cingulotomy and ventral capsule/ventral striatum deep brain stimulation for refractory obsessive-compulsive disorder with major depression: Do combined procedures have a long-term benefit?
Affiliations: Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea | Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
Note: [] Corresponding author: Chan-Hyung Kim, M.D., Ph.D., Department of Psychiatry, Severance Mental Health Hospital, Yonsei University College of Medicine, 696-6 Tanbul-dong, Gwangju-si, Gyeonggi-do 460-100, Republic of Korea. Tel.: +82 31 760 9530; Fax: +82 31 764 8662; E-mail: spr88@yuhs.ac
Note: [] Corresponding author: Jin Woo Chang, M.D., Ph.D., Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, 205 Seongsanno, Seodaemun-gu Seoul 120-752, Republic of Korea. Tel.: +82 2 2228 2159; Fax: +82 2 393 9979; E-mail: jchang@yuhs.ac
Abstract: Background: The ventral capsule (VC), ventral striatum (VS), and the anterior cingulate gyrus are parts of the obsessive-compulsive disorder (OCD) and depression circuits. We assessed whether a combination of bilateral anterior cingulotomy and VC/VS deep brain stimulation (DBS) had an additive effect in patients with OCD and major depression. Methods: Three patients with refractory OCD underwent combined bilateral anterior cingulotomy and VC/VS DBS procedures. All patients met the inclusion criteria for the Korean guidelines of DBS for OCD. Baseline Yale-Brown Obsessive-Compulsive Disorder Scale (Y-BOCS) scores, Hamilton Depression Rating Scale scores, and global assessments of functioning were evaluated. These scores were also serially estimated for more than 24 months after surgery at 3-month intervals. Results: The mean value of the baseline Y-BOCS scores was 34.7 (range 30–38); the mean Y-BOCS value decreased significantly to 23.0 (range 20–25) 3 months after the surgery. This score was maintained 2 years after surgery with a mean value of 19.0 (range 18–20). Conclusions: The combination of the two therapies did not yield superior outcomes, as the clinical outcomes were comparable to those of previous reports for VC/VS DBS alone. Wide-area VC/VS DBS may be sufficient to control refractory OCD.
