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Visser-Vandewalle V, Andrade P, Mosley PE, Greenberg BD, Schuurman R, McLaughlin NC, Voon V, Krack P, Foote KD, Mayberg HS, Figee M, Kopell BH, Polosan M, Joyce EM, Chabardes S, Matthews K, Baldermann JC, Tyagi H, Holtzheimer PE, Bervoets C, Hamani C, Karachi C, Denys D, Zrinzo L, Blomstedt P, Naesström M, Abosch A, Rasmussen S, Coenen VA, Schlaepfer TE, Dougherty DD, Domenech P, Silburn P, Giordano J, Lozano AM, Sheth SA, Coyne T, Kuhn J, Mallet L, Nuttin B, Hariz M, Okun MS. Deep brain stimulation for obsessive-compulsive disorder: a crisis of access. Nat Med 2022; 28:1529-1532. [PMID: 35840727 DOI: 10.1038/s41591-022-01879-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.
| | - Pablo Andrade
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Philip E Mosley
- Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, and Queensland Brain Institute, Brisbane, Queensland, Australia
| | - Benjamin D Greenberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Center for Neuromodulation, Butler Hospital, Providence, RI, USA.,RR&D Center for Neurorestoration and Neurotechnology, Providence, RI, USA
| | - Rick Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, the Netherlands
| | - Nicole C McLaughlin
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Behavioral Medicine and Addictions Research, Butler Hospital, Providence, Rhode Island, USA
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Kelly D Foote
- Department of Neurosurgery, University of Florida Health, Gainesville, FL, USA.,Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA
| | - Helen S Mayberg
- Departments of Neurology, Neurosurgery, Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martijn Figee
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian H Kopell
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mircea Polosan
- Fondation Fondamental, Créteil, France.,Centre Expert Troubles Bipolaires, Service Universitaire de Psychiatrie, Centre Hospitalier Universitaire de Grenoble et des Alpes, Grenoble, France.,Grenoble Institut des Neurosciences, Inserm U 836, La Tronche, France
| | - Eileen M Joyce
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Stephan Chabardes
- Department of Neurosurgery, Grenoble University Hospital, Grenoble, France
| | - Keith Matthews
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Juan C Baldermann
- Department of Neurology, University Hospital Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Himanshu Tyagi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Paul E Holtzheimer
- Departments of Psychiatry and Surgery, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Chris Bervoets
- Department of Neurosciences, Adult Psychiatry, UPC KU Leuven, Leuven, Belgium
| | - Clement Hamani
- Sunnybrook Research Institute, Division of Neurosurgery, University of Toronto, Toronto, Canada
| | - Carine Karachi
- Neurosurgery Department, Hôpital de la Salpêtrière, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | | | - Matilda Naesström
- Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Aviva Abosch
- Department of Neurosurgery and Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Rasmussen
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.,Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Deep Brain Stimulation, Freiburg University, Freiburg, Germany
| | - Thomas E Schlaepfer
- Department of Stereotactic and Functional Neurosurgery, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Deep Brain Stimulation, Freiburg University, Freiburg, Germany
| | - Darin D Dougherty
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, MA, USA
| | - Philippe Domenech
- Département Médico-Universitaire de Psychiatrie et d'Addictologie, Assistance Publique-Hôpitaux de Paris, Le Groupe Hospitalier Universitaire Henri Mondor, Université Paris-Est, Créteil, France.,Institut du Cerveau, Inserm U1127, CNRS UMR7225, Sorbonne Université, Paris, France
| | - Peter Silburn
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - James Giordano
- Department of Neurology, Georgetown University Medical Center, Washington, DC, USA.,Department of Biochemistry and Molecular & Cellular Biology, Georgetown University, Washington, DC, USA.,Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University, Washington, DC, USA
| | - Andres M Lozano
- Department of Neurosurgery and Neuroscience, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Terry Coyne
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University Hospital Cologne, and Faculty of Medicine, University of Cologne, Cologne, Germany.,Department of Psychiatry, Psychotherapy, and Psychosomatics, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | - Luc Mallet
- Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, University Paris-Est Créteil, Créteil, France.,Institut du Cerveau, Paris Brain Institute, Inserm, CNRS, Sorbonne Université, Paris, France.,Department of Mental Health and Psychiatry, Global Health Institute, University of Geneva, Geneva, Switzerland
| | - Bart Nuttin
- Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Marwan Hariz
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and UCLH National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,Unit for Deep Brain Stimulation, Umeå University, Umeå, Sweden
| | - Michael S Okun
- Department of Neurosurgery, University of Florida Health, Gainesville, FL, USA.,Norman Fixel Institute for Neurological Diseases, University of Florida Health, Gainesville, FL, USA.,Department of Neurology, University of Florida Health, Gainesville, FL, USA
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Merkl A, Aust S, Schneider GH, Visser-Vandewalle V, Horn A, Kühn AA, Kuhn J, Bajbouj M. Deep brain stimulation of the subcallosal cingulate gyrus in patients with treatment-resistant depression: A double-blinded randomized controlled study and long-term follow-up in eight patients. J Affect Disord 2018; 227:521-529. [PMID: 29161674 DOI: 10.1016/j.jad.2017.11.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/06/2017] [Accepted: 11/07/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG) is an experimental approach in treatment-resistant depression (TRD). Short-term results of efficacy in DBS are incongruent and studies investigating long-term effects are warranted. METHODS We assessed efficacy of SCG-DBS in eight patients randomized into a delayed-onset group (sham-DBS four weeks) and a non-delayed-onset group. The primary outcome measure was improvement on the Hamilton Depression Rating-Scale (HAMD-24-item-version). Response was defined as HAMD-24 reduction of at least 50% compared to baseline. Assessment was double-blind for a period of eight weeks and after 6,- 12,- 24,- and 28,- months open-label. RESULTS The average improvement in HAMD-24 scores after 6,- 12,- and 24-months were 34%, 25%, and 37%. After 6 months, HAMD-24 revealed a significant difference (P = .022) and 37.5% of the patients were responders. After 12 months, HAMD-24 scores dropped, but no significant difference was observed. After 24 months, a significant improvement was found (P = .041). After the four weeks lasting sham vs. DBS-ON period, there was no group difference (P = .376) in HAMD-24 and patients did not improve during sham stimulation. Patients were followed until 28 months and two up to 4 years under SCG-DBS and average response rate was 51%, whereas two patients were remitters (33,3%). LIMITATIONS The small sample size limited the statistical power and external validity. CONCLUSIONS Long-term improvement after SCG-DBS revealed a stable effect. There was no significant difference in response rates between the delayed and non-delayed-onset group. DBS for TRD remains experimental and longitudinal investigations of large samples are needed.
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Affiliation(s)
- Angela Merkl
- Department of Psychiatry, Charité - Universitätsmedizin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany; Department of Neurology, Charité - Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
| | - Sabine Aust
- Department of Psychiatry, Charité - Universitätsmedizin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin, Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Kerpener Str. 62, D-50937 Cologne, Germany
| | - Andreas Horn
- Department of Neurology, Charité - Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany; Laboratory for Brain Network Imaging and Modulation Berenson-Allen Center for Noninvasive Brain Stimulation Department for Neurology, Beth Israel Deaconess Center Harvard Medical School, 02215 Boston, United States
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - Jens Kuhn
- Department of Psychiatry, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Malek Bajbouj
- Department of Psychiatry, Charité - Universitätsmedizin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany
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