Acute stimulation effect of the ventral capsule/ventral striatum in patients with refractory obsessive–compulsive disorder – a double-blinded trial

Figures & data

Table 1 Patient characteristics and lead locations

Patient	Age at surgery (years), sex	OCD onset (years)	OCD duration (years)	Baseline YBOCS	Primary symptoms
Case 1	30, M	11	9	36	Fear of contamination, hand-washing
Case 2	30, M	16	11	36	Symmetrically checking his teeth, sexual thoughts, and ritualized bathing
Case 3	21, M	15	5	34	Fear of erotic images, beating his scrotum or eyeballs
Case 4	21, M	10	8	39	The fear of contamination, fear of death, hand-washing, spitting

Abbreviations: OCD, obsessive–compulsive disorder; YBOCS, Yale-Brown Obsessive Compulsive Scale; M, male.

Table 2 Results of left-side VC/VS DBS testing with the pulse width at 210 μs and the frequency at 130 Hz

Left-side Case number	Length of AC-PC line (mm)	Contact	x	y	z	Response Smile/laughter Min V	Patient comments
1	24.7	0	−6.7	15.5	−4.9	6	Smell at 6 and 8 V, chest tightness at 6 and 8 V
		1	−7.9	16.7	−2.0	6	Smell at 4–8 V, chest tightness at 4–8 V, increased sexual drive at 6–8 V, poor attention and memory, mouth numbness at 8 V
		2	−9.6	17.5	−0.1	6	Smell at 6–8 V, chest tightness at 4–8 V, increased sexual drive at 6–8 V, poor attention and memory, sweating at 8 V
		3	−11.1	18.9	3.0	−	Smell at 4–6 V, sweating at 8 V
2	28	0	−8.6	18.3	−4.9	6	–
		1	−10.1	19.5	−2.2	4	–
		2	−11.9	20.2	0.6	6	Chest tightness at 4 V, palpitation at 6 V, fear and nervousness at 8 V
		3	−13.6	20.7	3.4	–	Heat and palpitation at 4 V, sexual drive at 8 V
3	24.4	0	−7.1	13.4	−2.3	6	Smell at 8 V, dizziness at 4 and 8 V, nausea at 4 V, chest vibration at 6–8 V, heat at 6 V
		1	−8.4	14.6	0.4	4	Smell at 4–8 V, dizziness at 6–8 V, chest vibration at 6–8 V, heat at 8 V
		2	−10.4	15.8	3	4	Dizziness at 2–4 V, nausea at 4 V, chest vibration at 4–8 V
		3	−12.5	16.8	5.7	4	Smell at 2 V, dizziness at 2–4 V, chest vibration at 8 V
4	27	0	−7.2	14.9	−2.4	8	–
		1	−7.6	16	0.6	8	Dizziness at 8 V
		2	−9.3	16.8	3.7	–	–
		3	−11.3	17.8	6.8	–	Nausea at 6 V, dizziness at 8 V

Notes: x = lateral, y = anteroposterior, z = axial. Stimulation-induced effects were observed fewer and weaker at right-sided locations than at left-sided locations.

Abbreviations: AC-PC, anterior commissure-posterior commissure; DBS, deep-brain stimulation; VC/VS, ventral capsule/ventral striatum; Min, minimum.

Figure 1 Clinical outcomes at 15 months versus (vs) percentage of smile/laughter conditions of postoperative test stimulation.

Abbreviations: HAM-D, Hamilton Depression Rating Scale; YBOCS, Yale-Brown Obsessive Compulsive Scale.

Table 3 Changes in the severity of OCD, depression, and cognition after 15 months of VC/VSDBS

Variable	Baseline Mean ± SD	After 15 months of stimulation Mean ± SD	Percentage improvement	P-value
YBOCS total score	36.3±2.1	24.3±9.1	33.06%	0.001
HAM-D score	36.3±6.3	24.5±11.1	32.51%	0.005
WAIS-III FIQa	106	102	−3.77%	–

Note:

a Case 1 received neuropsychological assessment at baseline and 12 months after DBS surgery.

Abbreviations: DBS, deep-brain stimulation; FIQ, full-scale intelligence quotient; HAM-D, Hamilton Depression Rating Scale; OCD, obsessive–compulsive disorder; SD, standard deviation; VC/VS, ventral capsule/ventral striatum; WAIS-III, Wechsler Adult Intelligence Scale III; YBOCS, Yale-Brown Obsessive Compulsive Scale.

Figure 2 Postoperative test stimulation-induced mood change (euphoria) by lead contact and voltage.