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A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder.
Neurosurgery. 2020 Jul 02 [Online ahead of print]N

Abstract

BACKGROUND

Obsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated efficacy in improving symptoms in medically refractory patients. Multiple targets have been investigated.

OBJECTIVE

To systematically review the current level and quality of evidence supporting OCD-DBS by target region with the goal of establishing a common nomenclature.

METHODS

A systematic literature review was performed using the PubMed database and a patient/problem, intervention, comparison, outcome search with the terms "DBS" and "OCD." Of 86 eligible articles that underwent full-text review, 28 were included for review. Articles were excluded if the target was not specified, the focus on nonclinical outcomes, the follow-up period shorter than 3 mo, or the sample size smaller than 3 subjects. Level of evidence was assigned according to the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint guideline committee recommendations. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Selected publications included 9 randomized controlled trials, 1 cohort study, 1 case-control study, 1 cross-sectional study, and 16 case series. Striatal region targets such as the anterior limb of the internal capsule, ventral capsule/ventral striatum, and nucleus accumbens were identified, but stereotactic coordinates were similar despite differing structural names. Only 15 of 28 articles included coordinates.

CONCLUSION

The striatal area is the most commonly targeted region for OCD-DBS. We recommend a common nomenclature based on this review. To move the field forward to individualized therapy, active contact location relative to stereotactic coordinates and patient specific anatomical and clinical variances need to be reported.

Authors+Show Affiliations

Department of Neurosurgery, Albany Medical College, Albany, New York.Department of Neurosurgery, Albany Medical College, Albany, New York.Department of Neurosurgery, Albany Medical College, Albany, New York.Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.Department of Neurosurgery, Albany Medical College, Albany, New York. Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, New York.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32615588

Citation

Raviv, Nataly, et al. "A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder." Neurosurgery, 2020.
Raviv N, Staudt MD, Rock AK, et al. A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder. Neurosurgery. 2020.
Raviv, N., Staudt, M. D., Rock, A. K., MacDonell, J., Slyer, J., & Pilitsis, J. G. (2020). A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder. Neurosurgery. https://doi.org/10.1093/neuros/nyaa249
Raviv N, et al. A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder. Neurosurgery. 2020 Jul 2; PubMed PMID: 32615588.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder. AU - Raviv,Nataly, AU - Staudt,Michael D, AU - Rock,Andrew K, AU - MacDonell,Jacquelyn, AU - Slyer,Julia, AU - Pilitsis,Julie G, Y1 - 2020/07/02/ PY - 2019/12/13/received PY - 2020/04/11/accepted PY - 2020/7/3/entrez PY - 2020/7/3/pubmed PY - 2020/7/3/medline KW - Deep brain stimulation KW - Neuromodulation KW - Obsessive compulsive disorder KW - Striatum JF - Neurosurgery JO - Neurosurgery N2 - BACKGROUND: Obsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated efficacy in improving symptoms in medically refractory patients. Multiple targets have been investigated. OBJECTIVE: To systematically review the current level and quality of evidence supporting OCD-DBS by target region with the goal of establishing a common nomenclature. METHODS: A systematic literature review was performed using the PubMed database and a patient/problem, intervention, comparison, outcome search with the terms "DBS" and "OCD." Of 86 eligible articles that underwent full-text review, 28 were included for review. Articles were excluded if the target was not specified, the focus on nonclinical outcomes, the follow-up period shorter than 3 mo, or the sample size smaller than 3 subjects. Level of evidence was assigned according to the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint guideline committee recommendations. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS: Selected publications included 9 randomized controlled trials, 1 cohort study, 1 case-control study, 1 cross-sectional study, and 16 case series. Striatal region targets such as the anterior limb of the internal capsule, ventral capsule/ventral striatum, and nucleus accumbens were identified, but stereotactic coordinates were similar despite differing structural names. Only 15 of 28 articles included coordinates. CONCLUSION: The striatal area is the most commonly targeted region for OCD-DBS. We recommend a common nomenclature based on this review. To move the field forward to individualized therapy, active contact location relative to stereotactic coordinates and patient specific anatomical and clinical variances need to be reported. SN - 1524-4040 UR - https://www.unboundmedicine.com/medline/citation/32615588/A_Systematic_Review_of_Deep_Brain_Stimulation_Targets_for_Obsessive_Compulsive_Disorder L2 - https://academic.oup.com/neurosurgery/article-lookup/doi/10.1093/neuros/nyaa249 DB - PRIME DP - Unbound Medicine ER -
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