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Deep brain stimulation for obsessive-compulsive disorder: systematic review and evidence-based guideline sponsored by the American Society for Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons (CNS) and endorsed by the CNS and American Association of Neurological Surgeons.
Neurosurgery. 2014 Oct; 75(4):327-33; quiz 333.N

Abstract

BACKGROUND

It is estimated that 40% to 60% of patients with obsessive-compulsive disorder (OCD) continue to experience symptoms despite adequate medical management. For this population of treatment-refractory patients, promising results have been reported with the use of deep brain stimulation (DBS).

OBJECTIVE

To conduct a systematic review of the literature and develop evidence-based guidelines on DBS for OCD.

METHODS

A systematic literature search was undertaken using the PubMed database for articles published between 1966 and October 2012 combining the following words: "deep brain stimulation and obsessive-compulsive disorder" or "electrical stimulation and obsessive-compulsive disorder." Of 353 articles, 7 were retrieved for full-text review and analysis. The quality of the articles was assigned to each study and the strength of recommendation graded according to the guidelines development methodology of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Committee.

RESULTS

Of the 7 studies, 1 class I and 2 class II double-blind, randomized, controlled trials reported that bilateral DBS is more effective in improving OCD symptoms than sham treatment.

CONCLUSION

Based on the data published in the literature, the following recommendations can be made: (1) There is Level I evidence, based on a single class I study, for the use of bilateral subthalamic nucleus DBS for the treatment of medically refractory OCD. (2) There is Level II evidence, based on a single class II study, for the use of bilateral nucleus accumbens DBS for the treatment of medically refractory OCD. (3) There is insufficient evidence to make a recommendation for the use of unilateral DBS for the treatment of medically refractory OCD.

Authors+Show Affiliations

*Division of Neurosurgery, Toronto Western Hospital, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; ‡Department of Neurosurgery and Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, New York; §Neuroscience Institute, Maine Medical Center, Portland, Maine; ¶Department of Neurosurgery, Northwestern University, Chicago, Illinois; ‖Departments of Neurosurgery, Neurology, Anesthesiology, and Biomedical Engineering, University of Michigan, Ann Arbor, Michigan; #Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois; **Department of Neurosurgery, University of Colorado, Denver, Colorado; ‡‡Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts; §§Congress of Neurological Surgeons, Guidelines Department, Schaumburg, Illinois; ¶¶Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Practice Guideline
Review
Systematic Review

Language

eng

PubMed ID

25050579

Citation

Hamani, Clement, et al. "Deep Brain Stimulation for Obsessive-compulsive Disorder: Systematic Review and Evidence-based Guideline Sponsored By the American Society for Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons (CNS) and Endorsed By the CNS and American Association of Neurological Surgeons." Neurosurgery, vol. 75, no. 4, 2014, pp. 327-33; quiz 333.
Hamani C, Pilitsis J, Rughani AI, et al. Deep brain stimulation for obsessive-compulsive disorder: systematic review and evidence-based guideline sponsored by the American Society for Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons (CNS) and endorsed by the CNS and American Association of Neurological Surgeons. Neurosurgery. 2014;75(4):327-33; quiz 333.
Hamani, C., Pilitsis, J., Rughani, A. I., Rosenow, J. M., Patil, P. G., Slavin, K. S., Abosch, A., Eskandar, E., Mitchell, L. S., & Kalkanis, S. (2014). Deep brain stimulation for obsessive-compulsive disorder: systematic review and evidence-based guideline sponsored by the American Society for Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons (CNS) and endorsed by the CNS and American Association of Neurological Surgeons. Neurosurgery, 75(4), 327-33; quiz 333. https://doi.org/10.1227/NEU.0000000000000499
Hamani C, et al. Deep Brain Stimulation for Obsessive-compulsive Disorder: Systematic Review and Evidence-based Guideline Sponsored By the American Society for Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons (CNS) and Endorsed By the CNS and American Association of Neurological Surgeons. Neurosurgery. 2014;75(4):327-33; quiz 333. PubMed PMID: 25050579.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deep brain stimulation for obsessive-compulsive disorder: systematic review and evidence-based guideline sponsored by the American Society for Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons (CNS) and endorsed by the CNS and American Association of Neurological Surgeons. AU - Hamani,Clement, AU - Pilitsis,Julie, AU - Rughani,Anand I, AU - Rosenow,Joshua M, AU - Patil,Parag G, AU - Slavin,Konstantin S, AU - Abosch,Aviva, AU - Eskandar,Emad, AU - Mitchell,Laura S, AU - Kalkanis,Steven, AU - ,, AU - ,, AU - ,, PY - 2014/7/23/entrez PY - 2014/7/23/pubmed PY - 2015/7/15/medline SP - 327-33; quiz 333 JF - Neurosurgery JO - Neurosurgery VL - 75 IS - 4 N2 - BACKGROUND: It is estimated that 40% to 60% of patients with obsessive-compulsive disorder (OCD) continue to experience symptoms despite adequate medical management. For this population of treatment-refractory patients, promising results have been reported with the use of deep brain stimulation (DBS). OBJECTIVE: To conduct a systematic review of the literature and develop evidence-based guidelines on DBS for OCD. METHODS: A systematic literature search was undertaken using the PubMed database for articles published between 1966 and October 2012 combining the following words: "deep brain stimulation and obsessive-compulsive disorder" or "electrical stimulation and obsessive-compulsive disorder." Of 353 articles, 7 were retrieved for full-text review and analysis. The quality of the articles was assigned to each study and the strength of recommendation graded according to the guidelines development methodology of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Committee. RESULTS: Of the 7 studies, 1 class I and 2 class II double-blind, randomized, controlled trials reported that bilateral DBS is more effective in improving OCD symptoms than sham treatment. CONCLUSION: Based on the data published in the literature, the following recommendations can be made: (1) There is Level I evidence, based on a single class I study, for the use of bilateral subthalamic nucleus DBS for the treatment of medically refractory OCD. (2) There is Level II evidence, based on a single class II study, for the use of bilateral nucleus accumbens DBS for the treatment of medically refractory OCD. (3) There is insufficient evidence to make a recommendation for the use of unilateral DBS for the treatment of medically refractory OCD. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/25050579/Deep_brain_stimulation_for_obsessive_compulsive_disorder:_systematic_review_and_evidence_based_guideline_sponsored_by_the_American_Society_for_Stereotactic_and_Functional_Neurosurgery_and_the_Congress_of_Neurological_Surgeons__CNS__and_endorsed_by_the_CNS_and_American_Association_of_Neurological_Surgeons_ L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/NEU.0000000000000499 DB - PRIME DP - Unbound Medicine ER -