Subthalamic nucleus stimulation in severe obsessive-compulsive disorder.
N Engl J Med. 2008-11-13; 359(20): 2121-2134
DOI: 10.1056/nejmoa0708514
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1. N Engl J Med. 2008 Nov 13;359(20):2121-34. doi: 10.1056/NEJMoa0708514.
Subthalamic nucleus stimulation in severe obsessive-compulsive disorder.
Mallet L(1), Polosan M, Jaafari N, Baup N, Welter ML, Fontaine D, du Montcel ST,
Yelnik J, Chéreau I, Arbus C, Raoul S, Aouizerate B, Damier P, Chabardès S,
Czernecki V, Ardouin C, Krebs MO, Bardinet E, Chaynes P, Burbaud P, Cornu P,
Derost P, Bougerol T, Bataille B, Mattei V, Dormont D, Devaux B, Vérin M, Houeto
JL, Pollak P, Benabid AL, Agid Y, Krack P, Millet B, Pelissolo A; STOC Study
Group.
Collaborators: Mallet L, Agid Y, Aouizerate B, Arbus C, Bougerol T, Damier P,
Fontaine D, Houeto JL, Krebs MO, Lemaire JJ, Mallet L, Millet B, Pollak P,
Hourton D, Aprelon S, Jourdain C, Bardinet E, Yelnik J, Burbaud P, Welter ML,
Clair AH, Czernecki V, Vérin M, du Montcel ST, Madar D, Mallet L, Pelissolo A,
Agid Y, Cornu P, Navarro S, Welter ML, Hartmann A, Pidoux B, Grabli D, Czernecki
V, Dormont D, Galanaud D, Yelnik J, Bardinet E, Béhar C, Worbe Y, Clair AH,
Moutaud B, Aouizerate B, Burbaud P, Cuny E, Guehl D, Llorca PM, Chéreau I,
Lemaire JJ, Durif F, Derost P, Coste J, Gabrillargues J, Barget M, de Chazeron
I, Bougerol T, Polosan M, Benabid AL, Chabardès S, Seigneuret E, Krack P, Pollak
P, Ardouin C, Le Bas JF, Damier P, Lajat Y, Raoul S, Mattei V, Fontaine D, Borg
M, Paquis P, Magnie-Mauro MN, Robert P, Michel E, Papetti F, Baup N, Devaux B,
Krebs MO, Oppenheimer C, Olié JP, Ranoux D, Chayet M, Houeto JL, Jaafari N,
Bataille B, Mesnage V, Gil R, Audouin V, Senon JL, Millet B, Vérin M, Drapier D,
Sauleau P, Drapier S, Arbus C, Lazorthe Y, Chaynes P, Fabre N, Simonetta M,
Schmitt L, Lotterie JA, Camassel C, Best N, Aussilloux JC, Blond S, Feingold J,
Sicard D, Adès J, Cottraux J, Goudemand M.
Author information:
(1)The authors’ affiliations are listed in the Appendix.
Erratum in
N Engl J Med. 2009 Sep 3;361(10):1027.
Comment in
N Engl J Med. 2009 Feb 26;360(9):931; author reply 932. doi:
10.1056/NEJMc082508.
N Engl J Med. 2009 Feb 26;360(9):931-2; author reply 932.
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.
(ClinicalTrials.gov number, NCT00169377.)
2008 Massachusetts Medical Society
DOI: 10.1056/NEJMoa0708514
PMID: 19005196 [Indexed for MEDLINE]