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Long-term outcomes of nucleus accumbens/anterior limb of the internal capsule deep brain stimulation in treatment-resistant obsessive-compulsive disorder

Year: 2026

Type: article

Abstract: Background: Deep brain stimulation (DBS) is a therapeutic option for carefully selected patients with severe, treatment-resistant obsessive-compulsive disorder (OCD), but very long-term outcomes remain insufficiently characterized. We evaluated clinical outcomes after DBS targeting the nucleus accumbens/anterior limb of the internal capsule (NAcc/ALIC) over 3-21 years and described the trajectories of early responders, delayed responders, and non-responders. Methods: This single-center retrospective cohort included 30 consecutive patients (17 women) who underwent NAcc/ALIC DBS between 2004 and 2022. Outcomes were assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at baseline (T0), 1 year after surgery (T1), and the latest follow-up at ≥3 years (T2). Response was defined as a ≥35% reduction from baseline. Repeated-measures ANOVA with Bonferroni-adjusted pairwise comparisons was used to assess changes over time. Results: Y-BOCS scores decreased significantly across T0, T1, and T2. At T2, 22 of 30 patients (73.3%) met the response criterion; eight were delayed responders. Of the 15 patients who met the response criterion at T1, 14 retained it at T2 and 1 did not. Conclusion: Clinically meaningful improvement was sustained at long-term follow-up, and some patients who had not responded after 1 year met the response criterion later. Once response was achieved, subsequent loss of response appeared uncommon in this cohort. The retrospective design and heterogeneous follow-up duration preclude causal conclusions regarding DBS or the temporal course of improvement.

Source: Frontiers in Psychiatry

DOI: 10.3389/fpsyt.2026.1905823