{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:29:34Z","timestamp":1769725774920,"version":"3.49.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"20","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,11,17]]},"abstract":"\n BACKGROUND<\/jats:title>\n Deep brain stimulation (DBS) of the ventral capsule\/ventral striatum (VC\/VS) can alleviate symptoms of obsessive-compulsive disorder (OCD) refractory to conventional therapies. Overstimulation, however, can elicit pathological behaviors marked by disinhibition and recklessness.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n Two patients with OCD underwent DBS of the VC\/VS region and met responder status within 1 month of stimulation onset, as evidenced by a \u2265 35% reduction in their Yale-Brown Obsessive Compulsive Scale score. Notably, both patients exhibited signs of disinhibited behavior soon after DBS activation, including gambling, sleep disruption, and interpersonal relationship volatility. Through careful management, responder status persisted stably beyond the transient period of disinhibition.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n The unusually rapid improvement (weeks vs months) in OCD symptoms coincided with clinically significant disinhibited behavior. These findings support the role of VC\/VS DBS in promoting goal-oriented activation and underscore the importance of carefully monitoring the response to stimulation delivery. Managing disinhibited behavior often involves close clinical monitoring and careful titration of stimulation parameters in the initial weeks of DBS therapy. Prompt recognition of this potential stimulation-induced effect will allow providers to maintain patient safety and guide patients effectively toward optimal outcomes.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/abs\/10.3171\/CASE25411<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25411","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:09:34Z","timestamp":1769684974000},"source":"Crossref","is-referenced-by-count":0,"title":["Disinhibited behavior associated with rapid clinical response to deep brain stimulation for obsessive-compulsive disorder: illustrative cases"],"prefix":"10.3171","volume":"10","author":[{"given":"Sarah S.","family":"Soubra","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommy B.","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3895-8386","authenticated-orcid":true,"given":"Zain U.","family":"Naqvi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Hamre","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2292-1164","authenticated-orcid":true,"given":"Danika L.","family":"Paulo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kalman A.","family":"Katlowitz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nisha","family":"Giridharan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie van","family":"Arsdel","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan H.","family":"Bentley","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kasra A.","family":"Mansourian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4793-9907","authenticated-orcid":true,"given":"Davin","family":"Devara","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric A.","family":"Storch","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Baylor College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah R.","family":"Heilbronner","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8770-8965","authenticated-orcid":true,"given":"Sameer A.","family":"Sheth","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wayne","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Baylor College of Medicine, Houston, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6952-5417","authenticated-orcid":true,"given":"Nicole R.","family":"Provenza","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"10","key":"bib1","series-title":"Biol Psychiatry","first-page":"667","article-title":"Four deep brain stimulation targets for obsessive-compulsive disorder: are they different?","volume":"90","author":"Haber","year":"2021","unstructured":"Haber SNYendiki AJbabdi S.Four deep brain stimulation targets for obsessive-compulsive disorder: are they different? 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J Neurol Neurosurg Psychiatry. 2022:jnnp-2021-328738."},{"issue":"3","key":"bib5","series-title":"Am J Psychiatry","first-page":"265","article-title":"Efficacy of deep brain stimulation of the ventral anterior limb of the internal capsule for refractory obsessive-compulsive disorder: a clinical cohort of 70 patients","volume":"177","author":"Denys","year":"2020","unstructured":"Denys DGraat IMocking REfficacy of deep brain stimulation of the ventral anterior limb of the internal capsule for refractory obsessive-compulsive disorder: a clinical cohort of 70 patients. 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J Neurosci. 2025;45(37):e1321242025."},{"issue":"6","key":"bib22","series-title":"J Neurosurg","first-page":"1299","article-title":"Hypomania with hypersexuality following bilateral anterior limb stimulation in obsessive-compulsive disorder","volume":"112","author":"Chang","year":"2010","unstructured":"Chang CHChen SYHsiao YLTsai STTsai HC.Hypomania with hypersexuality following bilateral anterior limb stimulation in obsessive-compulsive disorder. J Neurosurg. 2010;112(6):1299-1300."},{"issue":"4","key":"bib23","series-title":"Psychiatry Clin Neurosci","first-page":"303","article-title":"Pilot study of deep brain stimulation in refractory obsessive-compulsive disorder ethnic Chinese patients","volume":"66","author":"Tsai","year":"2012","unstructured":"Tsai HCChang CHPan JIPilot study of deep brain stimulation in refractory obsessive-compulsive disorder ethnic Chinese patients. 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J Neurol Neurosurg Psychiatry. 2022:jnnp-2021-328738."},{"issue":"3","key":"bib5","series-title":"Am J Psychiatry","first-page":"265","article-title":"Efficacy of deep brain stimulation of the ventral anterior limb of the internal capsule for refractory obsessive-compulsive disorder: a clinical cohort of 70 patients","volume":"177","author":"Denys","year":"2020","unstructured":"Denys DGraat IMocking REfficacy of deep brain stimulation of the ventral anterior limb of the internal capsule for refractory obsessive-compulsive disorder: a clinical cohort of 70 patients. Am J Psychiatry. 2020;177(3):265-271."},{"issue":"9","key":"bib6","series-title":"World J Psychiatry","first-page":"659","article-title":"Deep brain stimulation for obsessive-compulsive disorder: a systematic review of worldwide experience after 20 years","volume":"11","author":"Mar-Barrutia","year":"2021","unstructured":"Mar-Barrutia LReal ESegal\u00e1s CBertol\u00edn SMench\u00f3n JMAlonso P.Deep brain stimulation for obsessive-compulsive disorder: a systematic review of worldwide experience after 20 years. World J Psychiatry. 2021;11(9):659-680."},{"issue":"10","key":"bib7","series-title":"Nat Med","first-page":"3004","article-title":"Disruption of neural periodicity predicts clinical response after deep brain stimulation for obsessive-compulsive disorder","volume":"30","author":"Provenza","year":"2024","unstructured":"Provenza NRReddy SAllam AKDisruption of neural periodicity predicts clinical response after deep brain stimulation for obsessive-compulsive disorder. 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Mol Psychiatry. 2010;15(1):64-79."},{"key":"bib10","series-title":"J Affect Disord","first-page":"69","article-title":"Is deep brain stimulation effective and safe for patients with obsessive compulsive disorder and comorbid bipolar disorder?","volume":"264","author":"Graat","year":"2020","unstructured":"Graat Ivan Rooijen GMocking RIs deep brain stimulation effective and safe for patients with obsessive compulsive disorder and comorbid bipolar disorder? J Affect Disord. 2020;264:69-75."},{"key":"bib11","series-title":"World Neurosurg","first-page":"e794","article-title":"Deep brain stimulation in the bed nucleus of stria terminalis in obsessive-compulsive disorder: 1-year follow-up","volume":"149","author":"Naesstr\u00f6m","year":"2021","unstructured":"Naesstr\u00f6m MHariz MStr\u00f6msten LBodlund OBlomstedt P.Deep brain stimulation in the bed nucleus of stria terminalis in obsessive-compulsive disorder: 1-year follow-up. 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