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Parkinson's Disease/Obsessive-Compulsive Disorder Helped By Brain Stimulation

Electrode implants into the subthalamic nucleus in two patients has improved their symptoms of Parkinson's disease as well as their decades long obsessive-compulsive disorder (OCD).

The results "raises the possibility that high-frequency stimulation could improve the functions of subcortical limbic circuitry in patients with severe OCD," declares Dr Luc Mallet and colleagues from Service de Psychiatrie, Hôpital de la Salpêtrière, Paris, France.

One of the patients, a 51-year-old woman with a five year history of Parkinson's disease, had severe levodopa-induced motor complications despite four years of optimum treatment. The patient also had a 33-year history of OCD. Her symptoms had remained constant over the years in which she developed and was treated for Parkinson's disease.

The second patient, a 50-year-old man with a 16-year history of Parkinson's disease, had severe dyskinesia and motor fluctuations. He had a 40-year history of OCD. His symptoms decreased when he reached adulthood, but became exacerbated with the onset of Parkinson's disease.

The woman patient had an electrode inserted between the anteromedial part of the subthalamic nucleus and the zona incerta, and another in the anterior part of the zona incerta. The male patient had an electrode implanted within the anteromedial part of the subthalamic nucleus and another between the anteromedial part of the subthalamic nucleus and the zona incerta.

Parkinsonian disability improved after electrode stimulation in both patients. Two weeks later their compulsions had disappeared and obsessive symptoms had improved. When last seen by the clinicians, neither patient had recurrence of the compulsions.

The clinicians said that the disappearance of compulsions and amelioration of obsessions in both patients are unlikely to be caused by natural variations in the severity of OCD, because their symptoms had existed for decades. Anti-anxiety drugs produce little improvement in patients with OCD, and stimulation of the subthalamic nucleus has little or no effect on anxiety in patients with Parkinson's disease.

"We believe that the reduction in symptoms of OCD was brought about by the inhibition of neuronal circuits in the subthalamic nucleus after bilateral stimulation of this area," Dr Mallet and colleague conclude.
Lancet 2002; 360: 1302-04.

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