Deep Brain Stimulation of the Nucleus Accumbens, Ventral Striatum, or Internal Capsule Targets for Medication-Resistant Obsessive-Compulsive Disorder: A Multicenter Study

Torres, Cristina V.; Treu, Svenja; Strange, Bryan A.; Lara, Mónica; Navas, Marta; Ezquiaga, Elena; Zazo, Elisa Seijo; Vicente, J. Sevilla; Muñiz, Isabel Gomila; Fernandez, Fernando Seijo

doi:10.1016/j.wneu.2021.08.039

Cited by 8 publications

(9 citation statements)

References 35 publications

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“…Our search strategy yielded a total of 3023 records (PubMed=841, EMBASE=2182) from 1986 to 2021. Thirty-four studies (n=352) from 2005 to 2021 were selected for systematic review and meta-analysis, including 9 RCTs (n=97)9 17 29–34 and 25 non-RCTs (n=255) 18–23 35–53. For more information on our search and selection process, see the PRISMA flow chart (figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…The most common described stimulation targets were VC/VS (six studies, n=63)18 35 37 40 52 55 and NAc (six studies, 53 patients)31 32 34 41 46 48 followed by ALIC (four studies, n=100),9 30 45 51 BNST (four studies, n=28),17 21 41 46 STN (three studies, n=47)29 44 53 and ALIC/BNST (three studies, n=37) 19 30 33. Other described target combinations included: NAc+VS+internal capsule (n=14),23 inferior thalamic peduncle (n=11),38 47 anteromedian STN+VC/VS (n=6),54 caudate nucleus (n=5),34 medial dorsal and ventral anterior nucleus of the thalamus (MD/VA) (n=4),42 superolateral branch of the medial forebrain bundle (n=2),43 STN+NAc (n=2),39 VS/ALIC (n=2),49 ALIC/NAc (n=2)50 and BNST/NAc (n=1) 46. Leads were implanted bilaterally in all cases except in one double-blind, sham-controlled RCT, which specifically targeted the right NAc (n=10).…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies used a Hamilton depression scale (nine HAM-D and five HDRS),9 23 30 32 33 35–37 39–41 47 50 51 seven studies used BDI,19 20 31 34 42 48 49 five studies used MADRS18 21 22 29 54 and one used the DASS-D46 to assess depression preoperatively and postoperatively. Of the 16 studies that reported anxiety scores, 11 used a Hamilton anxiety scale (9 HAM-A, 2 HARS),9 22 29 30 32–35 39 50 51 4 used STAI-X1/220 31 42 48 and 1 used DASS-A 46.…”

Section: Resultsmentioning

confidence: 99%

“…[13][14][15][16] However, since the most recent publication, one novel randomised controlled trial (RCT) 17 and at least six observational cohort studies have been published. [18][19][20][21][22][23]…”

Section: Introductionmentioning

confidence: 99%

“…To date, several meta-analyses have synthesised the body of evidence on DBS for OCD 13–16. However, since the most recent publication, one novel randomised controlled trial (RCT)17 and at least six observational cohort studies have been published 18–23. In addition, previous studies have not attempted to quantitatively assess bias in outcomes reporting which may improve confidence in the reported results of variously powered and designed studies.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of deep brain stimulation for treatment-resistant obsessive-compulsive disorder: systematic review and meta-analysis

Gadot

Najera

Hirani

et al. 2022

J Neurol Neurosurg Psychiatry

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Deep brain stimulation (DBS) is an established and growing intervention for treatment-resistant obsessive-compulsive disorder (TROCD). We assessed current evidence on the efficacy of DBS in alleviating OCD and comorbid depressive symptoms including newly available evidence from recent trials and a deeper risk of bias analysis than previously available. PubMed and EMBASE databases were systematically queried using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We included studies reporting primary data on multiple patients who received DBS therapy with outcomes reported through the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Primary effect measures included Y-BOCS mean difference and per cent reduction as well as responder rate (≥35% Y-BOCS reduction) at last follow-up. Secondary effect measures included standardised depression scale reduction. Risk of bias assessments were performed on randomised controlled (RCTs) and non-randomised trials. Thirty-four studies from 2005 to 2021, 9 RCTs (n=97) and 25 non-RCTs (n=255), were included in systematic review and meta-analysis based on available outcome data. A random-effects model indicated a meta-analytical average 14.3 point or 47% reduction (p<0.01) in Y-BOCS scores without significant difference between RCTs and non-RCTs. At last follow-up, 66% of patients were full responders to DBS therapy. Sensitivity analyses indicated a low likelihood of small study effect bias in reported outcomes. Secondary analysis revealed a 1 standardised effect size (Hedges’ g) reduction in depressive scale symptoms. Both RCTs and non-RCTs were determined to have a predominantly low risk of bias. A strong evidence base supports DBS for TROCD in relieving both OCD and comorbid depression symptoms in appropriately selected patients.

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Section: Resultsmentioning

confidence: 99%