Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years

Background: Twenty years after its first use in a patient with obsessive-compulsive disorder (OCD), the results confirm that deep brain stimulation (DBS) is a promising therapy for patients with severe and resistant forms of the disorder. Nevertheless, many unknowns remain, including the optimal ana...

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Detalhes bibliográficos
Autores: Mar Barrutia, Lorea, Real, Eva, Segalàs Cosi, Cinto, Bertolín Triquell, Sara, Menchón Magriñá, José Manuel, Alonso, Pino
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Recursos:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/182727
Acesso em linha:https://hdl.handle.net/2445/182727
Access Level:acceso abierto
Palavra-chave:Ansietat
Estimulació del cervell
Anxiety
Brain stimulation
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oai_identifier_str oai:diposit.ub.edu:2445/182727
network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years
title Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years
spellingShingle Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years
Mar Barrutia, Lorea
Ansietat
Estimulació del cervell
Anxiety
Brain stimulation
title_short Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years
title_full Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years
title_fullStr Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years
title_full_unstemmed Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years
title_sort Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years
dc.creator.none.fl_str_mv Mar Barrutia, Lorea
Real, Eva
Segalàs Cosi, Cinto
Bertolín Triquell, Sara
Menchón Magriñá, José Manuel
Alonso, Pino
author Mar Barrutia, Lorea
author_facet Mar Barrutia, Lorea
Real, Eva
Segalàs Cosi, Cinto
Bertolín Triquell, Sara
Menchón Magriñá, José Manuel
Alonso, Pino
author_role author
author2 Real, Eva
Segalàs Cosi, Cinto
Bertolín Triquell, Sara
Menchón Magriñá, José Manuel
Alonso, Pino
author2_role author
author
author
author
author
dc.subject.none.fl_str_mv Ansietat
Estimulació del cervell
Anxiety
Brain stimulation
topic Ansietat
Estimulació del cervell
Anxiety
Brain stimulation
description Background: Twenty years after its first use in a patient with obsessive-compulsive disorder (OCD), the results confirm that deep brain stimulation (DBS) is a promising therapy for patients with severe and resistant forms of the disorder. Nevertheless, many unknowns remain, including the optimal anatomical targets, the best stimulation parameters, the long-term (LT) effects of the therapy, and the clinical or biological factors associated with response. This systematic review of the articles published to date on DBS for OCD assesses the short and LT efficacy of the therapy and seeks to identify predictors of response. Aim: To summarize the existing knowledge on the efficacy and tolerability of DBS in treatment-resistant OCD. Methods: A comprehensive search was conducted in the PubMed, Cochrane, Scopus, and ClinicalTrials.gov databases from inception to December 31, 2020, using the following strategy: "(Obsessive-compulsive disorder OR OCD) AND (deep brain stimulation OR DBS)." Clinical trials and observational studies published in English and evaluating the effectiveness of DBS for OCD in humans were included and screened for relevant information using a standardized collection tool. The inclusion criteria were as follows: a main diagnosis of OCD, DBS conducted for therapeutic purposes and variation in symptoms of OCD measured by the Yale-Brown Obsessive-Compulsive scale (Y-BOCS) as primary outcome. Data were analyzed with descriptive statistics. Results: Forty articles identified by the search strategy met the eligibility criteria. Applying a follow-up threshold of 36 mo, 29 studies (with 230 patients) provided information on short-term (ST) response to DBS in, while 11 (with 155 patients) reported results on LT response. Mean follow-up period was 18.5 ± 8.0 mo for the ST studies and 63.7 ± 20.7 mo for the LT studies. Overall, the percentage of reduction in Y-BOCS scores was similar in ST (47.4%) and LT responses (47.2%) to DBS, but more patients in the LT reports met the criteria for response (defined as a reduction in Y-BOCS scores > 35%: ST, 60.6% vs LT, 70.7%). According to the results, the response in the first year predicts the extent to which an OCD patient will benefit from DBS, since the maximum symptom reduction was achieved in most responders in the first 12-14 mo after implantation. Reports indicate a consistent tendency for this early improvement to be maintained to the mid-term for most patients; but it is still controversial whether this improvement persists, increases or decreases in the long term. Three different patterns of LT response emerged from the analysis: 49.5% of patients had good and sustained response to DBS, 26.6% were non responders, and 22.5% were partial responders, who might improve at some point but experience relapses during follow-up. A significant improvement in depressive symptoms and global functionality was observed in most studies, usually (although not always) in parallel with an improvement in obsessive symptoms. Most adverse effects of DBS were mild and transient and improved after adjusting stimulation parameters; however, some severe adverse events including intracranial hemorrhages and infections were also described. Hypomania was the most frequently reported psychiatric side effect. The relationship between DBS and suicide risk is still controversial and requires further study. Finally, to date, no clear clinical or biological predictors of response can be established, probably because of the differences between studies in terms of the neuroanatomical targets and stimulation protocols assessed. Conclusion: The present review confirms that DBS is a promising therapy for patients with severe resistant OCD, providing both ST and LT evidence of efficacy.
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/182727
url https://hdl.handle.net/2445/182727
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.5498/wjp.v11.i9.659
World Journal of Psychiatry, 2021, vol 11,num 9, p. 659-680
https://doi.org/10.5498/wjp.v11.i9.659
dc.rights.none.fl_str_mv cc by-nc (c) Mar Barrutia, Lorea et al, 2021
http://creativecommons.org/licenses/by-nc/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by-nc (c) Mar Barrutia, Lorea et al, 2021
http://creativecommons.org/licenses/by-nc/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Baishideng Publishing Group Inc.
publisher.none.fl_str_mv Baishideng Publishing Group Inc.
dc.source.none.fl_str_mv Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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spelling Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 yearsMar Barrutia, LoreaReal, EvaSegalàs Cosi, CintoBertolín Triquell, SaraMenchón Magriñá, José ManuelAlonso, PinoAnsietatEstimulació del cervellAnxietyBrain stimulationBackground: Twenty years after its first use in a patient with obsessive-compulsive disorder (OCD), the results confirm that deep brain stimulation (DBS) is a promising therapy for patients with severe and resistant forms of the disorder. Nevertheless, many unknowns remain, including the optimal anatomical targets, the best stimulation parameters, the long-term (LT) effects of the therapy, and the clinical or biological factors associated with response. This systematic review of the articles published to date on DBS for OCD assesses the short and LT efficacy of the therapy and seeks to identify predictors of response. Aim: To summarize the existing knowledge on the efficacy and tolerability of DBS in treatment-resistant OCD. Methods: A comprehensive search was conducted in the PubMed, Cochrane, Scopus, and ClinicalTrials.gov databases from inception to December 31, 2020, using the following strategy: "(Obsessive-compulsive disorder OR OCD) AND (deep brain stimulation OR DBS)." Clinical trials and observational studies published in English and evaluating the effectiveness of DBS for OCD in humans were included and screened for relevant information using a standardized collection tool. The inclusion criteria were as follows: a main diagnosis of OCD, DBS conducted for therapeutic purposes and variation in symptoms of OCD measured by the Yale-Brown Obsessive-Compulsive scale (Y-BOCS) as primary outcome. Data were analyzed with descriptive statistics. Results: Forty articles identified by the search strategy met the eligibility criteria. Applying a follow-up threshold of 36 mo, 29 studies (with 230 patients) provided information on short-term (ST) response to DBS in, while 11 (with 155 patients) reported results on LT response. Mean follow-up period was 18.5 ± 8.0 mo for the ST studies and 63.7 ± 20.7 mo for the LT studies. Overall, the percentage of reduction in Y-BOCS scores was similar in ST (47.4%) and LT responses (47.2%) to DBS, but more patients in the LT reports met the criteria for response (defined as a reduction in Y-BOCS scores > 35%: ST, 60.6% vs LT, 70.7%). According to the results, the response in the first year predicts the extent to which an OCD patient will benefit from DBS, since the maximum symptom reduction was achieved in most responders in the first 12-14 mo after implantation. Reports indicate a consistent tendency for this early improvement to be maintained to the mid-term for most patients; but it is still controversial whether this improvement persists, increases or decreases in the long term. Three different patterns of LT response emerged from the analysis: 49.5% of patients had good and sustained response to DBS, 26.6% were non responders, and 22.5% were partial responders, who might improve at some point but experience relapses during follow-up. A significant improvement in depressive symptoms and global functionality was observed in most studies, usually (although not always) in parallel with an improvement in obsessive symptoms. Most adverse effects of DBS were mild and transient and improved after adjusting stimulation parameters; however, some severe adverse events including intracranial hemorrhages and infections were also described. Hypomania was the most frequently reported psychiatric side effect. The relationship between DBS and suicide risk is still controversial and requires further study. Finally, to date, no clear clinical or biological predictors of response can be established, probably because of the differences between studies in terms of the neuroanatomical targets and stimulation protocols assessed. Conclusion: The present review confirms that DBS is a promising therapy for patients with severe resistant OCD, providing both ST and LT evidence of efficacy.Baishideng Publishing Group Inc.2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/182727Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL))reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.5498/wjp.v11.i9.659World Journal of Psychiatry, 2021, vol 11,num 9, p. 659-680https://doi.org/10.5498/wjp.v11.i9.659cc by-nc (c) Mar Barrutia, Lorea et al, 2021http://creativecommons.org/licenses/by-nc/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1827272026-05-27T06:46:51Z
score 15,301603

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