Resident Physician Baylor College of Medicine Houston, Texas, United States
Introduction: Deep brain stimulation (DBS) has demonstrated efficacy for treating severe, refractory obsessive-compulsive disorder (OCD). One major advantage of DBS therapy is its adjustability; however, this flexibility also contributes in part to its underutilization as only a few experienced centers have expertise in programming these devices. Our objective was to outline a systematic strategy for selecting safe and effective DBS parameters for patients with OCD based on our experience treating a large cohort of patients.
Methods: We collected DBS programming parameters and standardized clinical assessment scores at post-operative visits for OCD patients implanted with investigational (n=5) and commercial (n=10) DBS devices targeting the ventral capsule/ventral striatum (VC/VS) region. Patients who received the investigational device as part of an NIH-funded trial underwent biweekly to monthly programming adjustments, while patients implanted with the commercial device were scheduled for as needed clinic visits for programming adjustments. At final follow-up, we calculated the total electrical energy delivered (1s) (TEED=I^2(A) x PW(s) x F(Hz) x R(ohm)) by each patient’s lead.
Results: A programming psychiatrist first identified the best stimulation contacts by performing a monopolar survey. Then stepwise parameter adjustments were made at each clinical visit with the goal of providing sufficient stimulation to improve measures of positive affect without precipitating side effects of hypomania. At a mean post-operative follow-up of 17 months, 10/15 patients (67%) achieved a full response, with at least a 35% reduction in the Yale-Brown Obsessive Compulsive Scale (YBOCS). Patients had a mean amplitude setting of 4.9 mA (SD: 1.4 mA) and total energy delivered of 466.0 microW (SD: 324.5 microW) for each DBS lead at final programming visit.
Conclusion : To increase patient access to DBS for refractory OCD, programming needs to become less dependent on a few experts. We sought to outline our successful stepwise programming strategy to encourage more widespread adoption of this therapy.
