Stimulation of bed nucleus of the stria terminalis area for treatment-resistant obsessive-compulsive disorder and comorbid depressive and anxiety symptoms: a systematic literature review

Abstract

Purpose: The bed nucleus of the stria terminalis (BNST) is a tiny nucleus connected by a bundle of axons with the amygdala. The BNST acts as a relay center, coordinating autonomic, limbic, behavioral, neuroendocrine, and motor functions. It plays a key role in anxiety and anxiety-related disorders. This review presents clinical outcomes of deep brain stimulation (DBS) of the BNST in treatment-resistant obsessive-compulsive disorder (trOCD) and treatment-resistant depression (TRD). Views: The medical literature search was conducted in MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL). The identified studies were assessed on the basis of patient characteristics, clinical outcomes, and adverse events related to DBS. The reduction of the Y-OCBS in the reported studies ranged from 27% to 66%, with mean reduction of the YBOCS of 45% at a mean of 58 months. The authors of clinical studies also reported enhanced socio-occupational functioning and quality of life. Adverse effects included hypomania, depressive episodes, weight gain, emotional lability, and seizures. However, most side effects were transient and reversible with stimulation adjustments. Conclusions: Clinical experience with BNST DBS remains limited, with most studies treating trOCD and only two addressing TRD. Reported outcomes suggest reductions in obsessions, compulsions, and affective symptoms, alongside improved daily functioning. The BNST appears to be a promising DBS target for anxiety-related psychiatric disorders.