Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?
Creators: name: Wu, Hemmings
name: Hariz, Marwan
name: Visser-Vandewalle, Veerle
name: Zrinzo, Ludvic
name: Coenen, Volker A.
name: Sheth, Sameer A.
name: Bervoets, Chris
name: Naesström, Matilda
name: Blomstedt, Patric
name: Coyne, Terry
name: Hamani, Clement
name: Slavin, Konstantin
name: Krauss, Joachim K.
name: Kahl, Kai G.
name: Taira, Takaomi
name: Zhang, Chencheng
name: Sun, Bomin
name: Toda, Hiroki
name: Schlaepfer, Thomas
name: Chang, Jin Woo
name: Régis, Jean
name: Schuurman, Rick
name: Schulder, Michael
name: Doshi, Paresh
name: Mosley, Philip
name: Poologaindran, Anujan
name: Lázaro-Muñoz, Gabriel
name: Pepper, Joshua
name: Schechtmann, Gaston
name: Fytagoridis, Anders
name: Huys, Daniel
name: Gonçalves-Ferreira, Antonio
name: D’Haese, Pierre-François
name: Neimat, Joseph
name: Broggi, Giovanni
name: Vilela-Filho, Osvaldo
name: Voges, Jürgen
name: Alkhani, Ahmed
name: Nakajima, Takeshi
name: Richieri, Raphaelle
name: Djurfeldt, Diana
name: Fontaine, Philippe
name: Martinez-Alvarez, Roberto
name: Okamura, Yasushi
name: Chandler, Jennifer
name: Watanabe, Katsushige
name: Barcia, Juan A.
name: Reneses, Blanca
name: Lozano, Andres
name: Gabriëls, Loes
name: De Salles, Antonio
name: Halpern, Casey H.
name: Matthews, Keith
name: Fins, Joseph J.
name: Nuttin, Bart
Publisher: name: Apollo - University of Cambridge Repository
Year: 2020
Subjects: Perspective
/692/699/476
/692/699/476/1414
perspective

description: Abstract: A consensus has yet to emerge whether deep brain stimulation (DBS) for treatment-refractory obsessive-compulsive disorder (OCD) can be considered an established therapy. In 2014, the World Society for Stereotactic and Functional Neurosurgery (WSSFN) published consensus guidelines stating that a therapy becomes established when “at least two blinded randomized controlled clinical trials from two different groups of researchers are published, both reporting an acceptable risk-benefit ratio, at least comparable with other existing therapies. The clinical trials should be on the same brain area for the same psychiatric indication.” The authors have now compiled the available evidence to make a clear statement on whether DBS for OCD is established therapy. Two blinded randomized controlled trials have been published, one with level I evidence (Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score improved 37% during stimulation on), the other with level II evidence (25% improvement). A clinical cohort study (N = 70) showed 40% Y-BOCS score improvement during DBS, and a prospective international multi-center study 42% improvement (N = 30). The WSSFN states that electrical stimulation for otherwise treatment refractory OCD using a multipolar electrode implanted in the ventral anterior capsule region (including bed nucleus of stria terminalis and nucleus accumbens) remains investigational. It represents an emerging, but not yet established therapy. A multidisciplinary team involving psychiatrists and neurosurgeons is a prerequisite for such therapy, and the future of surgical treatment of psychiatric patients remains in the realm of the psychiatrist.