Evolution of obsessive and compulsive symptoms over two years of deep brain stimulation cessation and explantation, after fourteen years of continuous stimulation for treatment-resistant obsessive-compulsive disorder. A case report

For two decades now, deep brain stimulation (DBS) has been a neuromodulation technique to treat patients with the most treatment-resistant obsessive-compulsive disorder (OCD). However, an extremely relevant issue is the tapering-off effect of DBS, but little data is available on the therapeutic benefits observed after the cessation of chronic stimulation. We report a patient with a broad history of treatment-resistant OCD who had chronic activated bilateral subthalamic nuclei DBS for fourteen years (procedure in 2005). The brain stimulation stopped due to a local skin infection near the implanted pulse generators. Surprisingly, neither recurrence of OCD symptoms nor serious complications were observed during the switched OFF-stimulation period, which lasted more than two years. This case illustrates that obsessive-compulsive symptoms can be stabilized post switched OFF DBS and maintained for months and reinforces the idea that clinicians could deliver stimulation on restricted periods rather than chronically. Since the data in the literature are almost non-existent on this question, only hypotheses can be suggested, as further studies are needed to unveil the underpinnings.