This study will include two parts. The first part will include two patients in a non-blinded, non-randomized, open trial. They will undergo Deep Bran Stimulation (DBS) for OCD (targeting the amSTN), as clinically accepted and approved in Israel (by the MOH) and in other countries in Europe and the US. The second part will include eight patients. This part will be an interventional, randomized, double-blinded clinical trial (patient and psychiatrist; the neurosurgeon will activate stimulation during the randomization period and will not be blinded). All subjects will undergo standard pre-operative psychiatric and neurosurgical assessment. Around 4-6 weeks later subjects will undergo implantation of Medtronic implantable DBS system (bilateral brain leads model 3389, lead extenders and PERCEPT pulse generator). Intraoperative recordings will include single unit and local field potentials (LFP) for target identification and validation, as accepted for clinical use. In the second part of the study, blinded randomization for treatment or sham-control arms (1:1 ratio) will be held two weeks post-operation. Treatment and sham-control arms will continue for four months. At the end of four months treatment, the groups will be crossed-over for another four months. Thus, the sham-control group will start treatment (using pre-defined stimulation parameters) and the treatment group will start sham stimulation. Four months later (six and a half months from surgery), randomization will be over, and both arms will get open-label active treatment. Psychiatric assessments post-operation will take place after two weeks, one month, and then once every six weeks, in the first year for all study patients. Chronic recordings will take place using the clinically used and approved PERCEPT DBS pulse generator during the first year after surgery.
Patients with a diagnosis of obsessive-compulsive disorder according to DSM 5 criteria, diagnosed by three independent psychiatrists not routinely involved with the patients' treatment.
Severe OCD assessed by the Yale-Brown Obsessive-Compulsive Scale (YBOCS) with a score of more than 25.
Refractory OCD; severe symptoms and impairment for more than 5 years despite pharmacological and psychological treatment.
Have failed to improve following treatment with at least two serotonin transport inhibitors and one augmenting agent taken for an adequate time period.
Diagnosis of severe major depression disorder (MDD) with psychotic features.
Significant suicidal risk [Hamilton Depression scale item 3 (suicide) >2].
Comorbidity with any primary Psychotic Disorder, Bipolar Disorder, Post-Traumatic Stress Disorder (PTSD), Eating Disorder, Autistics Spectrum Disorder.
History of substance or alcohol dependence or abuse in the preceding 12 months.
Crossover
Deep Bran Stimulation (DBS)
DeviceDeep brain stimulation (DBS) surgery targeting the antero-medial Sub-Thalamic Nucleus (amSTN)
Sham-stimulation
DeviceDeep brain stimulation (DBS) surgery - Sham stimulation
Assessment of the efficacy of amSTN/MFB stimulation on OCD symptoms - YBOCS score (0-40)
Assessment of the efficacy of amSTN/MFB stimulation on OCD symptoms. This will be assessed by the YBOCS. More than a 35% reduction on the YBOCS will be considered clinically significant. YBOCS score (0-40) - lower scores mean a better outcome.
Assessment of the efficacy of amSTN/MFB stimulation on OCD symptoms - YBOCS score (0-40)
Assessment of the efficacy of amSTN/MFB stimulation on OCD symptoms. This will be assessed by the YBOCS. More than a 35% reduction on the YBOCS will be considered clinically significant. YBOCS score (0-40) - lower scores mean a better outcome.
Assessment of the efficacy of amSTN/MFB stimulation on OCD symptoms - YBOCS score (0-40)
Assessment of the efficacy of amSTN/MFB stimulation on OCD symptoms. This will be assessed by the YBOCS. More than a 35% reduction on the YBOCS will be considered clinically significant. YBOCS score (0-40) - lower scores mean a better outcome.
Assessment of the efficacy of amSTN/MFB stimulation on OCD symptoms - YBOCS score (0-40)
Assessment of the efficacy of amSTN/MFB stimulation on OCD symptoms. This will be assessed by the YBOCS. More than a 35% reduction on the YBOCS will be considered clinically significant. YBOCS score (0-40) - lower scores mean a better outcome.
The effects of DBS on mood
The effects of DBS on mood and quality of life will be tested using various scales: Hamilton Scale for Anxiety (HAM-A), Hamilton Scale for Depression (HAM-D21), Brief Psychiatric Rating Scale (BPRS), overall state (Clinical Global Inventory \[CGI\]), and Mini-Mental State Examination (MMSE).
The effects of DBS on mood
The effects of DBS on mood and quality of life will be tested using various scales: Hamilton Scale for Anxiety (HAM-A), Hamilton Scale for Depression (HAM-D21), Brief Psychiatric Rating Scale (BPRS), overall state (Clinical Global Inventory \[CGI\]), and Mini-Mental State Examination (MMSE).
The effects of DBS on mood
The effects of DBS on mood and quality of life will be tested using various scales: Hamilton Scale for Anxiety (HAM-A), Hamilton Scale for Depression (HAM-D21), Brief Psychiatric Rating Scale (BPRS), overall state (Clinical Global Inventory \[CGI\]), and Mini-Mental State Examination (MMSE).
The effects of DBS on mood
The effects of DBS on mood and quality of life will be tested using various scales: Hamilton Scale for Anxiety (HAM-A), Hamilton Scale for Depression (HAM-D21), Brief Psychiatric Rating Scale (BPRS), overall state (Clinical Global Inventory \[CGI\]), and Mini-Mental State Examination (MMSE).
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