Deep Brain Stimulation of the Medial Forebrain Bundle in a Patient with Treatment-Resistant Bipolar Depression and Comorbid OCD : Acute and 12-Month Follow-Up Results

Limited but encouraging evidence exists on the efficacy of Deep Brain Stimulation (DBS) of the Medial Forebrain Bundle (MBF) in otherwise intractable patients with Major Depressive and Obsessive-Compulsive Disorder (OCD). Subject and Methods: Herein, we present acute and follow-up results (up to 12-months) of the first Italian patient, a 34 year old man with a diagnosis of treatment-resistant Bipolar Depression (BD) and comorbid OCD, successfully treated with DBS of the MFB. Periodic follow-up visits with psychometric evaluations highlighted a remarkable improvement of patient’s depressive and OC symptoms at 3 months (50-80% scores reduction), that was maintained at 6 and 12 months. In particular, suicidal ideation, which was found to be pervasive before the implant as well as patient’s overall disability, showed a rapid and significant acute response to DBS. Over the 12 months of stimulation, pre-implant pharmacological treatment could be gradually decreased, while the patient remained clinically stable. According to the limited, reported experience, we support the efficacy and tolerability of DBS of the MFB as a promising intervention in patients with treatment-resistant BD and comorbid OCD, particularly in relation to acute and post-acute outcome. Larger controlled trials are needed to confirm our findings and assess DBS therapeutic properties in the long-term.