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
1 CRICM - Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière
2 CIC AP-HP (pitie-Salpetriere)/inserm
3 Service de Psychiatrie
4 Immunologie antivirale systémique et cérébrale
5 Service de psychiatrie
6 Département de Neurologie [Paris]
7 Service de Neurochirurgie
8 Service d'informatique médicale
9 Service de psychiatrie
10 Service d'anatomie et cytologie pathologiques [Purpan]
11 Service de physiologie
12 Clinique neurologique
13 GIN - Grenoble Institut des Neurosciences
14 Centre De Référence National 'Syndrome Gilles de la Tourette', Pôle des Maladies du Système Nerveux [CHU Pitié-Salpêtrière]
15 UM des troubles du mouvement
16 CENIR - Centre de Neuro-Imagerie de Recherche
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
18 Service de Neurochirurgie [Rangueil]
19 PPSC - Physiologie et physiopathologie de la signalisation cellulaire
20 Service de Neurochirurgie [CHU Pitié-Salpêtrière]
21 Fondation FondaMental
22 Clinique Universitaire de Psychiatrie
23 Service de neuro-radiologie [CHU Pitié-Salpêtrière]
24 Service Neurochirurgie
25 UPD5 - Université Paris Descartes - Paris 5
26 Service de Neurologie [Rennes]
27 Service de neurologie [Poitiers]
28 Département de neurologie
29 CEA-LETI - Laboratoire d'Electronique et des Technologies de l'Information
30 Fédération des Maladies du Système Nerveux
31 Comportement et noyaux gris centraux [Rennes]
32 Service de psychiatrie
33 Service de psychiatrie adulte
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. (ClinicalTrials.gov number, NCT00169377.)
Type de document :
Article dans une revue
New England Journal of Medicine, Massachusetts Medical Society, 2008, 359 (20), pp.2121-34. 〈10.1056/NEJMoa0708514〉
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https://hal.inria.fr/hal-00805440
Contributeur : Olivier Colliot <>
Soumis le : mercredi 27 mars 2013 - 19:33:58
Dernière modification le : samedi 15 décembre 2018 - 01:47:46

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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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