Rebound of Affective Symptoms Following Acute Cessation of Deep Brain Stimulation in Obsessive-compulsive Disorder |
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| Institution: | 1. Department of Psychiatry, Academic Medical Center, University of Amsterdam, P.O. Box 75867, 1070 AW Amsterdam, the Netherlands;2. Arkin Mental Health Care, Amsterdam, the Netherlands;3. Trimbos Institute, Utrecht, the Netherlands;4. Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands;5. Netherlands Institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands;1. Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Universidad Politécnica de Madrid, Spain;2. University of Cadiz, Institute of Biomedical Research Cadiz (INiBICA), Cádiz, Spain;3. Hospital Nacional de Parapléjicos, FENNSI Group, Hospital Nacional de Parapléjicos, Toledo, Spain;4. Department of Psychiatry, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Spain;5. Department of Neurosurgery, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Spain;1. Unidad de Trastornos del Movimiento, Servicio de Neurología y Neurofisiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain;2. Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Spain;3. Stroke Unit, Dipartimento di Neuroscienze, Università di Roma Tor Vergata, Rome, Italy;4. Laboratorio di Neurologia Clinica e Comportamentale, Fondazione S. Lucia I.R.C.C.S., Rome, Italy;1. Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada;2. Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada;3. Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada;4. Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada;1. Division of Vascular Medicine, Department of Internal Medicine, Goethe University Hospital, Frankfurt am Main, Germany;2. Institute of Biostatistics and Math, Modelling, Faculty of Medicine, Goethe University Hospital, Frankfurt am Main, Germany |
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| Abstract: | BackgroundDeep brain stimulation (DBS) is regarded as an effective way to treat refractory obsessive-compulsive disorder (OCD). Little is known about the effects of DBS cessation following a longer period of stimulation.ObjectiveTo determine the relapse and rebound effects of psychiatric symptoms, and their impact on Quality of Life (QoL) following acute cessation of DBS in OCD patients.MethodsWe included 16 out of 32 patients who were treated with DBS between April 2005 and January 2011 at the Academic Medical Center, Amsterdam. After treatment for at least one year, patients entered a 1-week phase in which DBS was switched off. We evaluated psychiatric symptoms and QoL at three time points: before DBS surgery (pre-DBS), following at least one year of DBS treatment (DBS-on) and following 1 week of DBS off (DBS-off). Psychiatric symptoms were assessed with the Yale-Brown obsessive-compulsive disorder scale (Y-BOCS), the Hamilton anxiety rating scale (HAM-A) and the Hamilton depression rating scale (HAM-D). QoL was assessed using the World Health Organization QOL scale (WHOQOL-Bref).ResultsSwitching from DBS-on to DBS-off, Y-BOCS scores increased with 50%, HAM-A scores with 80% and HAM-D scores with 83%. In the DBS-off period, HAM-A and HAM-D scores exceeded pre-surgery levels with approximately 40%, suggesting a rebound phenomenon. Furthermore, a deterioration of physical and psychological QoL to levels comparable with pre-surgery was found during DBS-off.ConclusionAcute DBS cessation causes a relapse of obsessions and compulsions and a rebound of anxiety and depression. Additionally, improvements on QoL disappear. |
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| Keywords: | Deep brain stimulation Obsessive-compulsive disorder Rebound Quality of life |
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