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Deep brain stimulation (DBS) for refractory obsessive-compulsive disorder (OCD) usually targets behavior-generating systems like the ventral striatum or its fibers as they pass through the anterior limb of the internal capsule. These researchers addressed dysfunctional reward systems by targeting the nucleus accumbens in 16 patients with refractory OCD (illness duration, 8–46 years; 3–13 medication trials; 1–8 cognitive-behavioral therapy [CBT] trials).
Electrodes were implanted bilaterally in the nucleus accumbens. The study had three phases. The 8-month, open-label phase 1 involved active stimulation; weekly CBT started at week 8. In the double-blind, cross-over phase 2, patients were randomized to active or sham stimulation for 2 weeks an…