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Subthalamic nucleus stimulation in severe obsessive-compulsive disorder.

Luc Mallet 1, 2 Mircea Polosan 3 Nematollah Jaafari 4 Nicolas Baup 5 Marie-Laure Welter 1, 2, 6 Denys Fontaine 7 Sophie Tezenas Du Montcel 8 Jérôme Yelnik 1, 2 Isabelle Chéreau 9 Christophe Arbus 10 Sylvie Raoul 11 Bruno Aouizerate Philippe Damier 12 Stephan Chabardès 13 Virginie Czernecki 1, 14 Claire Ardouin 15 Marie-Odile Krebs 5 Eric Bardinet 1, 16, 17 Patrick Chaynes 18 Pierre Burbaud 19 Philippe Cornu 20 Philippe Derost Thierry Bougerol 21, 22 Benoit Bataille Vianney Mattei Didier Dormont 17, 23 Bertrand Devaux 24, 25 Marc Vérin 26 Jean-Luc Houeto 27 Pierre Pollak 13, 28 Alim-Louis Benabid 29 Yves Agid 30 Paul Krack 13, 28 Bruno Millet 31, 32 Antoine Pelissolo 33 Non Renseigné 
17 NEMESIS-CRICM - Equipe NEMESIS - Centre de Recherches de l'Institut du Cerveau et de la Moelle épinière
CRICM - Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière
Abstract : BACKGROUND: Severe, refractory obsessive-compulsive disorder (OCD) is a disabling condition. Stimulation of the subthalamic nucleus, a procedure that is already validated for the treatment of movement disorders, has been proposed as a therapeutic option. METHODS: In this 10-month, crossover, double-blind, multicenter study assessing the efficacy and safety of stimulation of the subthalamic nucleus, we randomly assigned eight patients with highly refractory OCD to undergo active stimulation of the subthalamic nucleus followed by sham stimulation and eight to undergo sham stimulation followed by active stimulation. The primary outcome measure was the severity of OCD, as assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), at the end of two 3-month periods. General psychopathologic findings, functioning, and tolerance were assessed with the use of standardized psychiatric scales, the Global Assessment of Functioning (GAF) scale, and neuropsychological tests. RESULTS: After active stimulation of the subthalamic nucleus, the Y-BOCS score (on a scale from 0 to 40, with lower scores indicating less severe symptoms) was significantly lower than the score after sham stimulation (mean [+/-SD], 19+/-8 vs. 28+/-7; P=0.01), and the GAF score (on a scale from 1 to 90, with higher scores indicating higher levels of functioning) was significantly higher (56+/-14 vs. 43+/-8, P=0.005). The ratings of neuropsychological measures, depression, and anxiety were not modified by stimulation. There were 15 serious adverse events overall, including 1 intracerebral hemorrhage and 2 infections; there were also 23 nonserious adverse events. CONCLUSIONS: These preliminary findings suggest that stimulation of the subthalamic nucleus may reduce the symptoms of severe forms of OCD but is associated with a substantial risk of serious adverse events. ( number, NCT00169377.)
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Submitted on : Wednesday, March 27, 2013 - 7:33:58 PM
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Luc Mallet, Mircea Polosan, Nematollah Jaafari, Nicolas Baup, Marie-Laure Welter, et al.. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder.. New England Journal of Medicine, Massachusetts Medical Society, 2008, 359 (20), pp.2121-34. ⟨10.1056/NEJMoa0708514⟩. ⟨hal-00805440⟩



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