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Title: Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response
Author: Alonso Ortega, María del Pino
Cuadras, Daniel
Gabriëls, Loes
Denys, Damiaan
Goodman, Wayne
Greenberg, Ben D
Jimenez Ponce, Fiacro
Kuhn, Jens
Lenartz, Doris
Mallet, Luc
Nuttin, Bart
Real, Eva
Segalàs, Cinto
Schuurman, Rick
du Montcel, Sophie Tezenas
Menchón Magriñá, José Manuel
Keywords: Qualitat de vida
Estimulació del cervell
Estimulació elèctrica
Quality of life
Brain stimulation
Electric stimulation
Issue Date: 2015
Publisher: Public Library of Science (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.
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It is part of: PLoS One, 2015, vol. 10, num. 7, p. e0133591
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ISSN: 1932-6203
Appears in Collections:Articles publicats en revistes (Ciències Clíniques)

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