Abstract
BackgroundDeep brain stimulation (DBS) has been proposed as an alternative to ablative neurosurgery for severe treatment-resistant Obsessive-Compulsive Disorder (OCD), although with partially discrepant results probably related to differences in anatomical targetting and stimulation conditions. We sought to determine the efficacy and tolerability of DBS in OCD and the existence of clinical predictors of response using meta-analysis.MethodsWe searched the literature on DBS for OCD from 1999 through January 2014 using PubMed/MEDLINE and PsycINFO. We performed fixed and random-effect meta-analysis with score changes (pre-post DBS) on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) as the primary-outcome measure, and the number of responders to treatment, quality of life and acceptability as secondary measures.FindingsThirty-one studies involving 116 subjects were identified. Eighty-three subjects were implanted in striatal areas—anterior limb of the internal capsule, ventral capsule and ventral striatum, nucleus accumbens and ventral caudate—27 in the subthalamic nucleus and six in the inferior thalamic peduncle. Global percentage of Y-BOCS reduction was estimated at 45.1% and global percentage of responders at 60.0%. Better response was associated with older age at OCD onset and presence of sexual/religious obsessions and compulsions. No significant differences were detected in efficacy between targets. Five patients dropped out, but adverse effects were generally reported as mild, transient and reversible.ConclusionsOur analysis confirms that DBS constitutes a valid alternative to lesional surgery for severe, therapy-refractory OCD patients. Well-controlled, randomized studies with larger samples are needed to establish the optimal targeting and stimulation conditions and to extend the analysis of clinical predictors of outcome.
Highlights
Obsessive-compulsive disorder (OCD) is characterized by the presence of upsetting, persistent thoughts, images, or impulses, which are experienced as intrusive and senseless and/or excessive repetitive behaviors or mental acts intended to neutralize the anxiety induced by the obsessions [1]
Our analysis confirms that Deep brain stimulation (DBS) constitutes a valid alternative to lesional surgery for severe, therapy-refractory Obsessive-Compulsive Disorder (OCD) patients
In the case of OCD, the therapeutic effect of DBS has been tentatively related to its capacity to modulate abnormal activity and synaptic connectivity in circuits involving the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC) and striatum [6], brain areas that have been implicated in the pathophysiology of the disorder [7]
Summary
Obsessive-compulsive disorder (OCD) is characterized by the presence of upsetting, persistent thoughts, images, or impulses, which are experienced as intrusive and senseless (obsessions) and/or excessive repetitive behaviors or mental acts (compulsions) intended to neutralize the anxiety induced by the obsessions [1]. Reductions in OCD severity in response to DBS range from 52–54% in patients receiving ventral capsule/ventral striatum (VC/VS) or nucleus accumbens (NA) stimulation to 41% in those with electrodes implanted in the subthalamic nucleus (STN) [8]. Percentage of responders–subjects with a reduction in their symptom severity of at least 35%–varies from 10% [9] to 61.5% [10] These discrepant results may be at least partially related to the differences in anatomical targeting, electrode design and stimulation protocols used. Deep brain stimulation (DBS) has been proposed as an alternative to ablative neurosurgery for severe treatment-resistant Obsessive-Compulsive Disorder (OCD), with partially discrepant results probably related to differences in anatomical targetting and stimulation conditions. We sought to determine the efficacy and tolerability of DBS in OCD and the existence of clinical predictors of response using meta-analysis
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