Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?

Hemmings Wu, Marwan Hariz, Veerle Visser-Vandewalle, Ludvic Zrinzo, Volker A. Coenen, Sameer A. Sheth, Chris Bervoets, Matilda Naesström, Patric Blomstedt, Terry Coyne, Clement Hamani, Konstantin Slavin, Joachim K. Krauss, Kai G. Kahl, Takaomi Taira, Chencheng Zhang, Bomin Sun, Hiroki Toda, Thomas Schlaepfer, Jin Woo ChangJean Régis, Rick Schuurman, Michael Schulder, Paresh Doshi, Philip Mosley, Anujan Poologaindran, Gabriel Lázaro-Muñoz, Joshua Pepper, Gaston Schechtmann, Anders Fytagoridis, Daniel Huys, Antonio Gonçalves-Ferreira, Pierre François D’Haese, Joseph Neimat, Giovanni Broggi, Osvaldo Vilela-Filho, Jürgen Voges, Ahmed Alkhani, Takeshi Nakajima, Raphaelle Richieri, Diana Djurfeldt, Philippe Fontaine, Roberto Martinez-Alvarez, Yasushi Okamura, Jennifer Chandler, Katsushige Watanabe, Juan A. Barcia, Blanca Reneses, Andres Lozano, Loes Gabriëls, Antonio De Salles, Casey H. Halpern, Keith Matthews, Joseph J. Fins, Bart Nuttin

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
JournalMolecular psychiatry
DOIs
StateAccepted/In press - 2020
Externally publishedYes

ASJC Scopus subject areas

  • Molecular Biology
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience

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