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Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response.

Alonso P, Cuadras D, Gabriëls L, Denys D, Goodman W, Greenberg BD, Jimenez-Ponce F, Kuhn J, Lenartz D, Mallet L, Nuttin B, Real E, Segalas C, Schuurman R, du Montcel ST, Menchon JM - PLoS ONE (2015)

Bottom Line: Global percentage of Y-BOCS reduction was estimated at 45.1% and global percentage of responders at 60.0%.No significant differences were detected in efficacy between targets.Five patients dropped out, but adverse effects were generally reported as mild, transient and reversible.

View Article: PubMed Central - PubMed

Affiliation: 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.

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.

No MeSH data available.


Related in: MedlinePlus

Flow of information according to PRISMA statement, study selection and reasons for exclusion.
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pone.0133591.g001: Flow of information according to PRISMA statement, study selection and reasons for exclusion.

Mentions: Flow of information according to PRISMA statement, study selection and reasons for exclusion are provided in Fig 1. Our electronic and reference list search found 301 studies, after discarding duplicates, that were potentially relevant to this meta-analysis. Of these, 270 were not included in the analysis because they met exclusion criteria. Thirty-three articles met the eligibility criteria (see Table 1). One was excluded because it was the abstract of a poster presentation [18] and another reported results on comorbid Anorexia Nervosa in an OCD patient treated with DBS but did not provide information on changes in OCD symptoms [19].


Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response.

Alonso P, Cuadras D, Gabriëls L, Denys D, Goodman W, Greenberg BD, Jimenez-Ponce F, Kuhn J, Lenartz D, Mallet L, Nuttin B, Real E, Segalas C, Schuurman R, du Montcel ST, Menchon JM - PLoS ONE (2015)

Flow of information according to PRISMA statement, study selection and reasons for exclusion.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4514753&req=5

pone.0133591.g001: Flow of information according to PRISMA statement, study selection and reasons for exclusion.
Mentions: Flow of information according to PRISMA statement, study selection and reasons for exclusion are provided in Fig 1. Our electronic and reference list search found 301 studies, after discarding duplicates, that were potentially relevant to this meta-analysis. Of these, 270 were not included in the analysis because they met exclusion criteria. Thirty-three articles met the eligibility criteria (see Table 1). One was excluded because it was the abstract of a poster presentation [18] and another reported results on comorbid Anorexia Nervosa in an OCD patient treated with DBS but did not provide information on changes in OCD symptoms [19].

Bottom Line: Global percentage of Y-BOCS reduction was estimated at 45.1% and global percentage of responders at 60.0%.No significant differences were detected in efficacy between targets.Five patients dropped out, but adverse effects were generally reported as mild, transient and reversible.

View Article: PubMed Central - PubMed

Affiliation: 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.

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.

No MeSH data available.


Related in: MedlinePlus