Management of stimulation-induced dyskinesia after subthalamic deep brain stimulation in a 19-year-old patient with obsessive-compulsive disorder: A case report

Abstract

Background Deep brain stimulation (DBS) is a promising treatment option for obsessive compulsive disorders (OCD). Here, we report the case of a young 19-year-old patient, diagnosed with severe OCD since the age of 12 and has exhibited contamination, accumulation and symmetry obsessions along with compulsions related to cleanliness and order since the age of 7. Methods DBS electrodes were implanted in the subthalamic nucleus (STN) under local anesthesia and electrophysiological targeting the antero-medial part of the nucleus. Results Before surgery, the score of Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was 40/40, the Montgomery-Åsberg Depression Rating Scale (MADRS) was 38/63 and the Young Mania Rating Scale (YMRS) was 8/60. Despite multiple pharmacological treatments, psychotherapy and repetitive transcranial magnetic stimulation, no significant improvement was observed. However, DBS of the associative/limbic part of the STN improved OCD symptoms (45%), depression (79%) and mania (100%). At the start of programming, monopolar stimulation was associated with troublesome dyskinesias, which have previously been reported as persistent motor side effects of STN DBS in OCD patients, sometimes making optimal DBS programming impossible. In our patient, we resolved dyskinesia issue by switching to bipolar stimulation, which proved effective without inducing dyskinesia. Conclusion Our results further support the use of STN DBS for the treatment of refractory OCD and mood disorders. The transition to bipolar stimulation maximized therapeutic effects without motor side effects. The patient's positive evolution confirms existing literature on the efficacy of this approach while underscoring the importance of a rigorous follow-up protocol and personalized stimulation parameter adjustments.