Subthalamic nucleus stimulation in severe obsessive-compulsive disorder.

Luc Mallet; Mircea Polosan; Nematollah Jaafari; Nicolas Baup; Marie-Laure Welter; Denys Fontaine; Sophie Tezenas Du Montcel; Jérôme Yelnik; Isabelle Chéreau; Christophe Arbus; Sylvie Raoul; Bruno Aouizerate; Philippe Damier; Stephan Chabardès; Virginie Czernecki; Claire Ardouin; Marie-Odile Krebs; Eric Bardinet; Patrick Chaynes; Pierre Burbaud; Philippe Cornu; Philippe Derost; Thierry Bougerol; Benoit Bataille; Vianney Mattei; Didier Dormont; Bertrand Devaux; Marc Vérin; Jean-Luc Houeto; Pierre Pollak; Alim-Louis Benabid; Yves Agid; Paul Krack; Bruno Millet; Antoine Pelissolo; Non Renseigné

doi:10.1056/NEJMoa0708514

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 [Créteil]

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〉

Domaine :

Informatique [cs] / Imagerie médicale

Liste complète des métadonnées

https://hal.inria.fr/hal-00805440
Contributeur : Olivier Colliot <>
Soumis le : mercredi 27 mars 2013 - 19:33:58
Dernière modification le : mardi 26 février 2019 - 10:12:45

Subthalamic nucleus stimulation in severe obsessive-compulsive disorder.

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