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Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response.
PLoS One. 2015; 10(7):e0133591.Plos

Abstract

BACKGROUND

Deep 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.

METHODS

We 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.

FINDINGS

Thirty-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.

CONCLUSIONS

Our 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.

Authors+Show Affiliations

OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain.Methodological and Statistical Assessment Unit, Parc Sanitari Sant Joan de Déu-Fundació Sant Joan de Déu, Barcelona, Spain.University Centre for OCD, Department of Psychiatry, UPC-KULeuven, Leuven, Belgium.Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, and the Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Butler Hospital, Providence, Rhode Island, United States of America.Unit of Stereotactic, Functional Neurosurgery and Radiosurgery, General Hospital of Mexico, Mexico City, Mexico.Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.UPMC-Inserm U1127-CNRS UMR7225, ICM-Brain & Spine Institute, Paris, France.Department of Neurosurgery, UZ Leuven, KU Leuven, Belgium.OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain.OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain.Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.UPMC Univ Paris 06, ER4, Modelling in Clinical Research, Paris, France; AP-HP, Hopitaux Universitaires Pitié-Salpétrière Charles-Foix, Department of Biostatistics and Medical Informatics, Paris, France.OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26208305

Citation

Alonso, Pino, et al. "Deep Brain Stimulation for Obsessive-Compulsive Disorder: a Meta-Analysis of Treatment Outcome and Predictors of Response." PloS One, vol. 10, no. 7, 2015, pp. e0133591.
Alonso P, Cuadras D, Gabriëls L, et al. Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response. PLoS ONE. 2015;10(7):e0133591.
Alonso, P., Cuadras, D., Gabriëls, L., Denys, D., Goodman, W., Greenberg, B. D., Jimenez-Ponce, F., Kuhn, J., Lenartz, D., Mallet, L., Nuttin, B., Real, E., Segalas, C., Schuurman, R., du Montcel, S. T., & Menchon, J. M. (2015). Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response. PloS One, 10(7), e0133591. https://doi.org/10.1371/journal.pone.0133591
Alonso P, et al. Deep Brain Stimulation for Obsessive-Compulsive Disorder: a Meta-Analysis of Treatment Outcome and Predictors of Response. PLoS ONE. 2015;10(7):e0133591. PubMed PMID: 26208305.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response. AU - Alonso,Pino, AU - Cuadras,Daniel, AU - Gabriëls,Loes, AU - Denys,Damiaan, AU - Goodman,Wayne, AU - Greenberg,Ben D, AU - Jimenez-Ponce,Fiacro, AU - Kuhn,Jens, AU - Lenartz,Doris, AU - Mallet,Luc, AU - Nuttin,Bart, AU - Real,Eva, AU - Segalas,Cinto, AU - Schuurman,Rick, AU - du Montcel,Sophie Tezenas, AU - Menchon,Jose M, Y1 - 2015/07/24/ PY - 2015/03/24/received PY - 2015/06/29/accepted PY - 2015/7/25/entrez PY - 2015/7/25/pubmed PY - 2016/5/6/medline SP - e0133591 EP - e0133591 JF - PloS one JO - PLoS ONE VL - 10 IS - 7 N2 - BACKGROUND: Deep 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. METHODS: We 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. FINDINGS: Thirty-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. CONCLUSIONS: Our 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. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/26208305/Deep_Brain_Stimulation_for_Obsessive_Compulsive_Disorder:_A_Meta_Analysis_of_Treatment_Outcome_and_Predictors_of_Response_ L2 - http://dx.plos.org/10.1371/journal.pone.0133591 DB - PRIME DP - Unbound Medicine ER -