38 Chapter 2 INTRODUCTION In 2010, we published a case report on substantial weight loss in an obese patient with intractable obsessive-compulsive disorder (OCD) treated by deep brain stimulation (DBS) (1). This patient was amongst the first that we treated with DBS for OCD, and had a very good response reflected by an improvement of >90% on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Interestingly, after the OCD symptoms had disappeared, she quit smoking effortlessly, and, with the help of a dietician, started a program to lose weight. Her body mass index (BMI) went rapidly from 37 to 25, starting 10 months after surgery, with a further reduction to 21 which was retained during 7 years of follow-up. Case reports can spark new ideas or shed light on a particular aspect of a disorder or treatment. Conversely, selective publication of single effects can lead to a distortion of the available evidence for treatment application or lead to duplication of research efforts (2). Therefore, after our initial observation, we analyzed the changes in body weight over time in our entire sample of patients treated with DBS in the ventral part of the anterior limb of the internal capsule (vALIC) (3) for either OCD or major depressive disorder (MDD). METHODS The records of all patients undergoing DBS surgery between April 2005 and June 2014 for OCD and MDD were evaluated. For baseline weight and BMI data, we used values measured at the department of anesthesiology before the initial electrode implantation. For follow-up data, we used the most recently available value for the BMI measured by anesthesiology before subsequent operations for stimulator replacements, or measured at the department of psychiatry during follow-up visits. In order to study the relation between possible changes in BMI and the effect of therapy, patients were categorized as responders or nonresponders at the time of this follow-up for BMI. A responder was defined as having an improvement of >35% on the Y-BOCS for OCD, or >50% on the Hamilton Depression Rating Scale (HDRS) for MDD, in comparison to the preoperative baseline score. IBM SPSS Statistics for Windows, v20 was used for statistical analysis and the paired Student t test was carried out to assess the average change in BMI over time. ANOVA was performed for the comparison of BMI changes for different body weight groups (morbidly obese, obese, and nonobese) and the treatment response.
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