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The Medial Forebrain Bundle as a Target for Deep Brain Stimulation for Obsessive-compulsive Disorder

Volker Arnd CoenenThomas SchläpferPeter Ludwig GollPeter ReinacherUlrich VoderholzerLudger Tebartz van ElstHorst UrbachTobias Freyer

出版	Universität, 2017
URL	http://books.google.com.hk/books?id=U2CvzwEACAAJ&hl=&source=gbs_api

註釋Abstract: Deep brain stimulation (DBS) is a promising putative modality for the treatment of refractory psychiatric disorders such as major depression and obsessive-compulsive disorder (OCD). Several targets have been posited; however, a clear consensus on differential efficacy and possible modes of action remain unclear. DBS to the supero-lateral branch of the medial forebrain bundle (slMFB) has recently been introduced for major depression (MD). Due to our experience with slMFB stimulation for MD, and because OCD might be related to similar dysfunctions of the reward system, treatment with slMFB DBS seams meaningful. Here we describe our first 2 cases together with a hypothetical mode of action.

We describe diffusion tensor imaging (DTI) fiber tractographically (FT)-assisted implantation of the bilateral DBS systems in 2 male patients. In a selected literature overview, we discuss the possible mode of action. Both patients were successfully implanted and stimulated. The follow-up time was 12 months. One patient showed a significant response (Yale-Brown Obsessive-Compulsive Scale [YBOCS] reduction by 35%); the other patient reached remission criteria 3 months after surgery (YBOCS14) and showed mild OCD just above the remission criterion at 12 months follow-up.br