Deep brain stimulation for obsessive-compulsive disorder: A systematic review of randomised controlled trials

Vicheva, Petya; Butler, Matthew; Shotbolt, Paul

doi:10.1016/j.neubiorev.2020.01.007

Cited by 34 publications

(30 citation statements)

References 42 publications

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“…In theory, the effectiveness of CBT may also depend on the preoperative cognitive state of the patient, as well as on the potential cognitive side effects of DBS. Whereas in patients with Parkinson’s disease, cognitive side effects of DBS—especially of the subthalamic nucleus—have been associated with reduced processing speed and working memory [ 22 ], there is little evidence of any detrimental effect of DBS—of any target—on the cognitive performance of OCD patients [ 23 ]. Studies that do report on neuropsychological measures report no relevant change in cognitive performance after DBS [ 24 ], and in one case even an improvement in cognitive flexibility for STN DBS but not for VC/VS DBS [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness, Timing and Procedural Aspects of Cognitive Behavioral Therapy after Deep Brain Stimulation for Therapy-Resistant Obsessive Compulsive Disorder: A Systematic Review

Görmezoğlu

Vlis

Schruers

et al. 2020

JCM

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Background and aim: Deep brain stimulation (DBS) is an effective treatment for patients with severe therapy-resistant obsessive-compulsive disorder (OCD). After initiating DBS many patients still require medication and/or behavioral therapy to deal with persisting symptoms and habitual behaviors. The clinical practice of administering postoperative cognitive behavioral therapy (CBT) varies widely, and there are no clinical guidelines for this add-on therapy. The aim of this review is to assess the efficacy, timing and procedural aspects of postoperative CBT in OCD patients treated with DBS. Method: Systematic review of literature. Results: The search yielded 5 original studies, one case series and three reviews. Only two clinical trials have explicitly focused on the effectiveness of CBT added to DBS in patients with therapy-resistant OCD. These two studies both showed effectiveness of CBT. However, they had a distinctly different design, very small sample sizes and different ways of administering the therapy. Therefore, no firm conclusions can be drawn or recommendations made for administering CBT after DBS for therapy-resistant OCD. Conclusion: The effectiveness, timing and procedural aspects of CBT added to DBS in therapy-resistant OCD have hardly been studied. Preliminary evidence indicates that CBT has an added effect in OCD patients being treated with DBS. Since the overall treatment effect is the combined result of DBS, medication and CBT, future trials should be designed in such a way that they allow quantification of the effects of these add-on therapies in OCD patients treated with DBS. Only in this way information can be gathered that contributes to the development of an algorithm and clinical guidelines for concomittant therapies to optimize treatment effects in OCD patients being treated with DBS.

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Section: Discussionmentioning

confidence: 99%

Effectiveness, Timing and Procedural Aspects of Cognitive Behavioral Therapy after Deep Brain Stimulation for Therapy-Resistant Obsessive Compulsive Disorder: A Systematic Review

Görmezoğlu

Vlis

Schruers

et al. 2020

JCM

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“…DBS is an invasive neuromodulation technique that is effective in managing clinical symptoms of neurological and psychiatric disorders, such as Parkinson’s disease (PD) [ 23 , 24 ] and OCD [ 25 ]. At stimulation settings commonly used in clinical practice, DBS decreases the spontaneous firing of neuronal populations and activates axonal projections near the electrode [ 26 ].…”

Section: Deep Brain Stimulation For Treatment-resistant Depressionmentioning

confidence: 99%

Deep Brain Stimulation for Treatment-Resistant Depression: Towards a More Personalized Treatment Approach

Roet

Boonstra

Şahin

et al. 2020

JCM

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Major depressive disorder (MDD) affects approximately 4.4% of the world’s population. One third of MDD patients do not respond to routine psychotherapeutic and pharmacotherapeutic treatment and are said to suffer from treatment-resistant depression (TRD). Deep brain stimulation (DBS) is increasingly being investigated as a treatment modality for TRD. Although early case studies showed promising results of DBS, open-label trials and placebo-controlled studies have reported inconsistent outcomes. This has raised discussion about the correct interpretation of trial results as well as the criteria for patient selection, the choice of stimulation target, and the optimal stimulation parameters. In this narrative review, we summarize recent studies of the effectiveness of DBS in TRD and address the relation between the targeted brain structures and clinical outcomes. Elaborating upon that, we hypothesize that the effectiveness of DBS in TRD can be increased by a more personalized and symptom-based approach. This may be achieved by using resting-state connectivity mapping for neurophysiological subtyping of TRD, by using individualized tractography to help decisions about stimulation target and electrode placement, and by using a more detailed registration of symptomatic improvements during DBS, for instance by using ‘experience sampling’ methods.

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“…Neurosurgical management of mental disorders with psychosurgery refers to destruction of histologically normal brain tissue in order to achieve symptomatic relief for affl icted patients suffering from debilitating and intractable psychiatric disorders who have exhausted other therapeutic options [23,24]. Cingulotomy, subcaudate tractotomy, limbic leucotomy, capsulotomy, magnetic resonance-guided focused ultrasound, and neurostimulatory interventions such as deep brain stimulation and transcranial magnetic stimulation are among the utilized procedures [20,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. Nevertheless, thorough consideration of the ethical aspect is a critical issue for implementation of these procedures with some controversies and potential restrictions in different regions around the globe [41][42][43][44][45][46].…”

Section: Defi Nition Of Psychosurgerymentioning

confidence: 99%

Obsessive compulsive disorder (ocd) as a severe mental health disorder: A concise review of management with radiosurgery for intractable disease

Sager¹,

Beyzadeoğlu²,

Dincoglan³

et al. 2020

J Surg Surgical Res

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fi rst-line therapeutic strategies including exposure and response prevention, cognitive-bahavioural-therapy, and pharmacological agents such as selective serotonin reuptake inhibitors and tricyclic antidepressants may result in clinical improvement in majority of patients, however, approximately 20% of patients have refractory OCD unresponsive to fi rst-line management, and a subgroup of patients unresponsive to fi rstline therapies suffer from severe debilitating symptoms referred to as intractable OCD. No consensus exists for management of patients with intractable OCD and treatment decisions

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Deep brain stimulation for obsessive-compulsive disorder: A systematic review of randomised controlled trials

Cited by 34 publications

References 42 publications

Effectiveness, Timing and Procedural Aspects of Cognitive Behavioral Therapy after Deep Brain Stimulation for Therapy-Resistant Obsessive Compulsive Disorder: A Systematic Review

Effectiveness, Timing and Procedural Aspects of Cognitive Behavioral Therapy after Deep Brain Stimulation for Therapy-Resistant Obsessive Compulsive Disorder: A Systematic Review

Deep Brain Stimulation for Treatment-Resistant Depression: Towards a More Personalized Treatment Approach

Obsessive compulsive disorder (ocd) as a severe mental health disorder: A concise review of management with radiosurgery for intractable disease

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