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Habenular Stimulation for Neurosurgery Resistant Obsessive-Compulsive Disorder: A Case Report

BACKGROUND: Some patients suffer from persistent and severely disabling Obsessive-Compulsive Disorder (OCD) symptoms that cannot be alleviated by conventional treatments or neuroablative interventions targeting cortico-striatal loop circuits. Currently, it is unclear how to manage the clinical sympt...

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Autores principales: Zhang, Chencheng, Zhang, Yingying, Li, Dianyou, Deng, Zhengdao, Nuttin, Bart, Voon, Valerie, Sun, Bomin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025519/
https://www.ncbi.nlm.nih.gov/pubmed/32116846
http://dx.doi.org/10.3389/fpsyt.2020.00029
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author Zhang, Chencheng
Zhang, Yingying
Li, Dianyou
Deng, Zhengdao
Nuttin, Bart
Voon, Valerie
Sun, Bomin
author_facet Zhang, Chencheng
Zhang, Yingying
Li, Dianyou
Deng, Zhengdao
Nuttin, Bart
Voon, Valerie
Sun, Bomin
author_sort Zhang, Chencheng
collection PubMed
description BACKGROUND: Some patients suffer from persistent and severely disabling Obsessive-Compulsive Disorder (OCD) symptoms that cannot be alleviated by conventional treatments or neuroablative interventions targeting cortico-striatal loop circuits. Currently, it is unclear how to manage the clinical symptoms of these unique patients. We reasoned that deep brain stimulation (DBS) of the habenula (HB) could be a valuable subsequent treatment option for these otherwise medically intractable cases of severe OCD. The HB is an epithalamic structure critically involved in the encoding and responding to aversive stimulus events, cognitive and brain processes known to be impaired in many patients with OCD. Similarly, HB DBS can alleviate depression and anxiety, which often co-occur with OCD. Here, we explore the clinical benefits and risks of HB DBS treatment in a patient with severe and refractory OCD. CASE PRESENTATION: A 30-year-old male patient presented with persistent and severely disabling OCD symptoms that were refractory to previous psychological and pharmacological treatments as well as to neuroablative surgical interventions involving both capsulotomy and cingulotomy. After HB DBS, however, the severity of the patient's OCD symptoms was markedly reduced at 1-month follow-up, which was sustained until the final (at 12-month) follow-up. The patient also reported enduring improvements in depression, anxiety, and health-related quality of life after several months of HB DBS treatment. CONCLUSIONS: This case report provides the first clinical evidence suggesting that HB DBS could serve as a safe and effective alternative neurosurgical intervention for severe and refractory OCD. The present findings are promising and warrant further research into the role of the HB in pathophysiology and treatment of OCD.
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spelling pubmed-70255192020-02-28 Habenular Stimulation for Neurosurgery Resistant Obsessive-Compulsive Disorder: A Case Report Zhang, Chencheng Zhang, Yingying Li, Dianyou Deng, Zhengdao Nuttin, Bart Voon, Valerie Sun, Bomin Front Psychiatry Psychiatry BACKGROUND: Some patients suffer from persistent and severely disabling Obsessive-Compulsive Disorder (OCD) symptoms that cannot be alleviated by conventional treatments or neuroablative interventions targeting cortico-striatal loop circuits. Currently, it is unclear how to manage the clinical symptoms of these unique patients. We reasoned that deep brain stimulation (DBS) of the habenula (HB) could be a valuable subsequent treatment option for these otherwise medically intractable cases of severe OCD. The HB is an epithalamic structure critically involved in the encoding and responding to aversive stimulus events, cognitive and brain processes known to be impaired in many patients with OCD. Similarly, HB DBS can alleviate depression and anxiety, which often co-occur with OCD. Here, we explore the clinical benefits and risks of HB DBS treatment in a patient with severe and refractory OCD. CASE PRESENTATION: A 30-year-old male patient presented with persistent and severely disabling OCD symptoms that were refractory to previous psychological and pharmacological treatments as well as to neuroablative surgical interventions involving both capsulotomy and cingulotomy. After HB DBS, however, the severity of the patient's OCD symptoms was markedly reduced at 1-month follow-up, which was sustained until the final (at 12-month) follow-up. The patient also reported enduring improvements in depression, anxiety, and health-related quality of life after several months of HB DBS treatment. CONCLUSIONS: This case report provides the first clinical evidence suggesting that HB DBS could serve as a safe and effective alternative neurosurgical intervention for severe and refractory OCD. The present findings are promising and warrant further research into the role of the HB in pathophysiology and treatment of OCD. Frontiers Media S.A. 2020-02-07 /pmc/articles/PMC7025519/ /pubmed/32116846 http://dx.doi.org/10.3389/fpsyt.2020.00029 Text en Copyright © 2020 Zhang, Zhang, Li, Deng, Nuttin, Voon and Sun http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Zhang, Chencheng
Zhang, Yingying
Li, Dianyou
Deng, Zhengdao
Nuttin, Bart
Voon, Valerie
Sun, Bomin
Habenular Stimulation for Neurosurgery Resistant Obsessive-Compulsive Disorder: A Case Report
title Habenular Stimulation for Neurosurgery Resistant Obsessive-Compulsive Disorder: A Case Report
title_full Habenular Stimulation for Neurosurgery Resistant Obsessive-Compulsive Disorder: A Case Report
title_fullStr Habenular Stimulation for Neurosurgery Resistant Obsessive-Compulsive Disorder: A Case Report
title_full_unstemmed Habenular Stimulation for Neurosurgery Resistant Obsessive-Compulsive Disorder: A Case Report
title_short Habenular Stimulation for Neurosurgery Resistant Obsessive-Compulsive Disorder: A Case Report
title_sort habenular stimulation for neurosurgery resistant obsessive-compulsive disorder: a case report
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025519/
https://www.ncbi.nlm.nih.gov/pubmed/32116846
http://dx.doi.org/10.3389/fpsyt.2020.00029
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