Alonso, Pino ORCID: 0000-0002-5779-9111, Cuadras, Daniel ORCID: 0000-0001-8780-1764, Gabriels, Loes, Denys, Damiaan, Goodman, Wayne, Greenberg, Ben D., Jimenez-Ponce, Fiacro, Kuhn, Jens, Lenartz, Doris, Mallet, Luc ORCID: 0000-0001-8061-1167, Nuttin, Bart, Real, Eva, Segalas, Cinto ORCID: 0000-0002-0959-0356, Schuurman, Rick, du Montcel, Sophie Tezenas ORCID: 0000-0002-2866-4330 and Menchon, Jose M. (2015). Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response. PLoS One, 10 (7). SAN FRANCISCO: PUBLIC LIBRARY SCIENCE. ISSN 1932-6203

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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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Alonso, PinoUNSPECIFIEDorcid.org/0000-0002-5779-9111UNSPECIFIED
Cuadras, DanielUNSPECIFIEDorcid.org/0000-0001-8780-1764UNSPECIFIED
Gabriels, LoesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Denys, DamiaanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Goodman, WayneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Greenberg, Ben D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jimenez-Ponce, FiacroUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kuhn, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lenartz, DorisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mallet, LucUNSPECIFIEDorcid.org/0000-0001-8061-1167UNSPECIFIED
Nuttin, BartUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Real, EvaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Segalas, CintoUNSPECIFIEDorcid.org/0000-0002-0959-0356UNSPECIFIED
Schuurman, RickUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
du Montcel, Sophie TezenasUNSPECIFIEDorcid.org/0000-0002-2866-4330UNSPECIFIED
Menchon, Jose M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-398667
DOI: 10.1371/journal.pone.0133591
Journal or Publication Title: PLoS One
Volume: 10
Number: 7
Date: 2015
Publisher: PUBLIC LIBRARY SCIENCE
Place of Publication: SAN FRANCISCO
ISSN: 1932-6203
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
SUBTHALAMIC NUCLEUS STIMULATION; ANTERIOR CAPSULAR STIMULATION; ELECTRICAL-STIMULATION; MAJOR DEPRESSION; ACCUMBENS; DISEASE; PATIENTMultiple languages
Multidisciplinary SciencesMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/39866

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