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P-1128 - Acute Effects of Different Stimulation Settings via Implanted Electrodes in the bed Nucleus of the Stria Terminalis/ventral Striatum-internal Capsule in Treatment-resistant Obsessive Compulsive Disorder

Published online by Cambridge University Press:  15 April 2020

L. Winter
Affiliation:
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany Department of Neurosurgery, Hannover Medical School, Hannover, Germany
G. Lütjens
Affiliation:
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany Department of Neurosurgery, Hannover Medical School, Hannover, Germany
K. Schwabe
Affiliation:
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany Department of Neurosurgery, Hannover Medical School, Hannover, Germany
A. Saryyeva
Affiliation:
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany Department of Neurosurgery, Hannover Medical School, Hannover, Germany
H.E. Heissler
Affiliation:
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany Department of Neurosurgery, Hannover Medical School, Hannover, Germany
M. Alam
Affiliation:
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany Department of Neurosurgery, Hannover Medical School, Hannover, Germany
Y. Zhang
Affiliation:
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany Department of Neurosurgery, Hannover Medical School, Hannover, Germany
K.G. Kahl
Affiliation:
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany Department of Neurosurgery, Hannover Medical School, Hannover, Germany
J.K. Krauss
Affiliation:
Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover, Germany Department of Neurosurgery, Hannover Medical School, Hannover, Germany

Abstract

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Introduction

Deep brain stimulation (DBS) in different targets emerges as a promising therapeutic option for patients with treatment-resistant obsessive compulsive disorder (trOCD). We here describe the acute effects of different stimulation settings on OCD symptoms and mood states in a patient with trOCD after implantation of DBS electrodes in the bed nucleus of the stria terminalis/ventral striatum-internal capsule (BNST/VS-IC).

Method

Quadripolar DBS electrodes (Medtronic 3387) were implanted bilaterally with stereotactic guidance and microelectrode recordings in the BNST/VS-IC. Electrode location was confirmed via postoperative stereotactic CT. On the following day, the target was stimulated using different amplitudes (1V, 2V, 3.5V) and different contacts (0−/1+, 0−/3+, 2−/3+) with a constant pulse width of 210 μsec and a frequency of 130 Hz for 5 minutes, respectively. OCD symptoms and mood states were assessed by an independent rater using visual analogue scales.

Results

Subjective intensity of obsessive-compulsive thoughts was reduced most by acute stimulation with 2V but, however, deteriorated with higher amplitudes. Subjective feelings of pleasure and spontaneous smiling were induced also at low voltage. Stimulation of different contact pairs located either in the BNST (0−/1+) or in the IC (2−/3+), and combined stimulation (0−/3+) produced differential and particularly specific effects.

Discussion

We show acute effects on core symptoms of OCD after stimulation in the BNST/VS-IC. The induction of positive feelings accompanied symptom reduction. One hypothesis to explain our finding is that the induction of pleasure and smiling may be an epiphenomenon of stimulation of a ‘sweet-spot’ that ameliorates OCD symptoms after stimulation.

Type
Abstract
Copyright
Copyright © European Psychiatric Association 2012
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