Incidental resolution of pedophilia in a patient undergoing deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD): a case report and long-term follow-up.

BACKGROUND: Deep brain stimulation (DBS) is a highly effective treatment for severe obsessive-compulsive disorder (OCD) by regulating neural activity within the cortico-striato-thalamo-cortical (CSTC) circuit. However, its effects on co-occurring conditions are not well understood. This report highlights an extraordinary case where DBS, used to treat OCD, unexpectedly resolved pedophilic tendencies in a patient. CASE PRESENTATION: A 36-year-old man with severe refractory OCD underwent DBS surgery after failing multiple treatments. He also had comorbid pedophilia, diagnosed according to DSM-5 criteria. Following Bed Nucleus of the Stria Terminalis and the Anterior Limb of the Internal Capsule (BNST/ALIC) DBS, his OCD symptoms improved significantly, with a 32% reduction in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score over six months. Notably, his pedophilic desires resolved gradually post-surgery, documented through serial psychiatrist-led clinical interviews conducted across follow-up visits. At 58-month follow-up, both conditions remained in remission without medication. The patient’s autonomy and consent were respected throughout the process. CONCLUSION: A patient with severe OCD and pedophilia underwent DBS, experiencing significant improvement in OCD symptoms and unexpected resolution of pedophilic desires, raising complex ethical considerations for future treatments.