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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

Forest Plot for percentage of improvement in Y-BOCS scores.
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pone.0133591.g002: Forest Plot for percentage of improvement in Y-BOCS scores.

Mentions: Patient-level data relating to Y-BOCS score changes were available for 13 studies, including 66 patients. Mean percentages of reduction, standard deviation and standard error for each study were calculated to perform the meta-analysis on the percentage of improvement. The fixed effect model could not be used since it overestimates the percentage of improvement due to the excessive weight of Mallet et al.’s results [21] in two patients with high and almost identical percentages of improvement. The random effect model estimates the global percentage of improvement at 45.1% (95% CI = 29.4% to 60.8%). This wide confidence interval can be attributed to the reduced sample size of the studies as well as to their heterogeneity (Q = 734.6, df = 12, p <0.0001; I2 = 96.4%) (see Fig 2 for the associated Forest Plot)


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)

Forest Plot for percentage of improvement in Y-BOCS scores.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0133591.g002: Forest Plot for percentage of improvement in Y-BOCS scores.
Mentions: Patient-level data relating to Y-BOCS score changes were available for 13 studies, including 66 patients. Mean percentages of reduction, standard deviation and standard error for each study were calculated to perform the meta-analysis on the percentage of improvement. The fixed effect model could not be used since it overestimates the percentage of improvement due to the excessive weight of Mallet et al.’s results [21] in two patients with high and almost identical percentages of improvement. The random effect model estimates the global percentage of improvement at 45.1% (95% CI = 29.4% to 60.8%). This wide confidence interval can be attributed to the reduced sample size of the studies as well as to their heterogeneity (Q = 734.6, df = 12, p <0.0001; I2 = 96.4%) (see Fig 2 for the associated Forest Plot)

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