Superolateral medial forebrain bundle deep brain stimulation for obsessive-compulsive disorder in both spouses of a married couple – Couple case report

Abstract

This case report presents the unique story of a married couple, Mr. A and Mrs. B, who both suffered from severe obsessive–compulsive disorder (OCD) as well as mild to moderate depression, and underwent superolateral medial forebrain bundle deep brain stimulation (slMFB DBS) together. Mr. A struggled with fear of making mistakes and ritualistic behaviors, while Mrs. B experienced magical thinking and order obsessions when they met each other during one of their psychiatric hospital stays. After hospitalization, they quickly became a couple and decided to start a life together, culminating in marriage a few years later. Despite various treatments, the couple’s conditions remained a formidable challenge, leading them to ultimately opt for DBS together. DBS has emerged as a promising intervention for severe, treatment-resistant OCD cases, yet optimal target regions remain debated. The slMFB has recently garnered attention as a potential target due to its connectivity with reward pathways and involvement in OCD. Following surgery and postoperative management, both patients experienced substantial improvements in OCD symptoms, with reductions in intrusive thoughts and compulsive behaviors. Additionally, their depressive symptoms notably decreased. Around 15 months after the surgeries, the couple welcomed their first child. Long-term follow-up revealed sustained improvements, allowing them to actively engage in familial and professional endeavors. Mr. A successfully completed training and secured full-time employment, while Mrs. B resumed work and household responsibilities. Their experiences underscore the efficacy of slMFB DBS in alleviating OCD symptoms and associated depression, enhancing overall quality of life.