Subthalamic nucleus stimulation in severe obsessive-compulsive disorder.
- Type de publi. : Article dans une revue
- Date de publi. : 13/11/2008
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Auteurs :
Luc MalletMircea PolosanNematollah JaafariNicolas BaupMarie-Laure WelterDenys FontaineSophie Tezenas Du MontcelJérôme YelnikIsabelle ChéreauChristophe ArbusSylvie RaoulBruno AouizeratePhilippe DamierStephan ChabardèsVirginie CzerneckiClaire ArdouinMarie-Odile KrebsEric BardinetPatrick ChaynesPierre BurbaudPhilippe CornuPhilippe DerostThierry BougerolBenoit BatailleVianney MatteiDidier DormontBertrand DevauxMarc VérinJean-Luc HouetoPierre PollakAlim-Louis BenabidYves AgidPaul KrackBruno MilletAntoine PelissoloNon Renseigné
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Organismes :
Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière
CIC AP-HP (pitie-Salpetriere)/inserm
Service de Psychiatrie
Immunologie antivirale systémique et cérébrale
Centre Hospitalier Sainte-Anne [Paris]
Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière
CIC AP-HP (pitie-Salpetriere)/inserm
CHU Pitié-Salpêtrière [AP-HP]
Service de Neurochirurgie
CHU Pitié-Salpêtrière [AP-HP]
Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière
CIC AP-HP (pitie-Salpetriere)/inserm
Service Psychiatrie Adulte [CHU Clermont-Ferrand]
Service Anatomie et cytologie pathologiques [CHU Toulouse]
Service de physiologie
Clinique neurologique
Grenoble Institut des Neurosciences
Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière
CHU Pitié-Salpêtrière [AP-HP]
UM des troubles du mouvement
Centre Hospitalier Sainte-Anne [Paris]
Centre de Recherche de l'Institut du Cerveau et de la Moelle épinière
Plateforme de neuroimagerie CENIR = Center for NeuroImaging Research-Human MRI Neuroimaging core facility for clinical research [ICM Paris]
Equipe NEMESIS - Centre de Recherches de l'Institut du Cerveau et de la Moelle épinière
Service Neurochirurgie [CHU Toulouse]
Physiologie et physiopathologie de la signalisation cellulaire
CHU Pitié-Salpêtrière [AP-HP]
Fondation FondaMental [Créteil]
Clinique Universitaire de Psychiatrie
Equipe NEMESIS - Centre de Recherches de l'Institut du Cerveau et de la Moelle épinière
CHU Pitié-Salpêtrière [AP-HP]
Centre Hospitalier Sainte-Anne [Paris]
Université Paris Descartes - Paris 5
Service de Neurologie [Rennes] = Neurology [Rennes]
Service de neurologie [CHU de Poitiers]
Grenoble Institut des Neurosciences
Département de neurologie
Commissariat à l'énergie atomique et aux énergies alternatives - Laboratoire d'Electronique et de Technologie de l'Information
CHU Pitié-Salpêtrière [AP-HP]
Grenoble Institut des Neurosciences
Département de neurologie
Comportement et noyaux gris centraux = Behavior and Basal Ganglia [Rennes]
Service de psychiatrie
CHU Pitié-Salpêtrière [AP-HP]
- Publié dans New England Journal of Medicine le 29/10/2020
Résumé : 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.)
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