Disinhibited behavior associated with rapid clinical response to deep brain stimulation for obsessive-compulsive disorder: illustrative cases.

BACKGROUND: 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. OBSERVATIONS: 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 ≥ 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. LESSONS: 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. https://thejns.org/doi/abs/10.3171/CASE25411.