A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder

Mosley，Philip E.1,2,3,4; Windels，François3; Morris，John3; Coyne，Terry3,5; Marsh，Rodney2,4; Giorni，Andrea3; Mohan，Adith6,7; Sachdev，Perminder6,7; O’Leary，Emily8; Boschen，Mark9; Sah，Pankaj3,10; Silburn，Peter A.2,3

2021-06-01

10.1038/s41398-021-01307-9

Translational Psychiatry   影响因子和分区

2158-3188

Deep brain stimulation (DBS) is a promising treatment for severe, treatment-resistant obsessive-compulsive disorder (OCD). Here, nine participants (four females, mean age 47.9 ± 10.7 years) were implanted with DBS electrodes bilaterally in the bed nucleus of the stria terminalis (BNST). Following a one-month postoperative recovery phase, participants entered a three-month randomised, double-blind, sham-controlled phase before a twelve-month period of open-label stimulation incorporating a course of cognitive behavioural therapy (CBT). The primary outcome measure was OCD symptoms as rated with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). In the blinded phase, there was a significant benefit of active stimulation over sham (p = 0.025, mean difference 4.9 points). After the open phase, the mean reduction in YBOCS was 16.6 ± 1.9 points (χ (11) = 39.8, p = 3.8 × 10), with seven participants classified as responders. CBT resulted in an additive YBOCS reduction of 4.8 ± 3.9 points (p = 0.011). There were two serious adverse events related to the DBS device, the most severe of which was an infection during the open phase necessitating device explantation. There were no serious psychiatric adverse events related to stimulation. An analysis of the structural connectivity of each participant’s individualised stimulation field isolated right-hemispheric fibres associated with YBOCS reduction. These included subcortical tracts incorporating the amygdala, hippocampus and stria terminalis, in addition to cortical regions in the ventrolateral and ventromedial prefrontal cortex, parahippocampal, parietal and extrastriate visual cortex. In conclusion, this study provides further evidence supporting the efficacy and tolerability of DBS in the region of the BNST for individuals with otherwise treatment-refractory OCD and identifies a connectivity fingerprint associated with clinical benefit.

SCI ; SSCI

英语

其他

WOS:000636309900003

2-s2.0-85103563862

Scopus

1.Systems Neuroscience Group,QIMR Berghofer Medical Research Institute,Herston,Australia
2.Neurosciences Queensland,St Andrew’s War Memorial Hospital,Spring Hill,Australia
3.Queensland Brain Institute,University of Queensland,St Lucia,Australia
4.Faculty of Medicine,University of Queensland,Herston,Australia
5.Brizbrain and Spine,the Wesley Hospital,Auchenflower,Australia
6.Centre for Healthy Brain Ageing (CHeBA),School of Psychiatry,University of New South Wales,Sydney,Australia
7.Neuropsychiatric Institute,The Prince of Wales Hospital,Randwick,Australia
8.The OCD Clinic,Bulimba,Australia
9.School of Applied Psychology,Griffith University,Gold Coast,Australia
10.Joint Center for Neuroscience and Neural Engineering,and Department of Biology,Southern University of Science and Technology,Shenzhen,China

Mosley，Philip E.,Windels，François,Morris，John,et al. A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder[J]. Translational Psychiatry,2021,11(1).

Mosley，Philip E..,Windels，François.,Morris，John.,Coyne，Terry.,Marsh，Rodney.,...&Silburn，Peter A..(2021).A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder.Translational Psychiatry,11(1).

Mosley，Philip E.,et al."A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder".Translational Psychiatry 11.1(2021).