Long-term comparative effectiveness of deep brain stimulation in severe obsessive-compulsive disorder

Background: Twenty years after the first use of Deep Brain Stimulation (DBS) in obsessive-compulsive disorder (OCD), our knowledge of the long-term effects of this therapeutic option remains very limited. Objective: Our study aims to assess the long-term effectiveness and tolerability of DBS in OCD...

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Autores: Mar Barrutia, Lorea, Ibarrondo, Oliver, Mar, Javier, Real, Eva, Segalàs Cosi, Cinto, Bertolín Triquell, Sara, Aparicio, Marco Alberto, Plans, Gerard, Menchón Magriñá, José Manuel, Alonso, Pino
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2022
País:España
Recursos:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/189123
Acesso em linha:https://hdl.handle.net/2445/189123
Access Level:acceso abierto
Palavra-chave:Neurosi obsessiva
Efectes secundaris
Obsessive-compulsive disorder
Side effects
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spelling Long-term comparative effectiveness of deep brain stimulation in severe obsessive-compulsive disorderMar Barrutia, LoreaIbarrondo, OliverMar, JavierReal, EvaSegalàs Cosi, CintoBertolín Triquell, SaraAparicio, Marco AlbertoPlans, GerardMenchón Magriñá, José ManuelAlonso, PinoNeurosi obsessivaEfectes secundarisObsessive-compulsive disorderSide effectsBackground: Twenty years after the first use of Deep Brain Stimulation (DBS) in obsessive-compulsive disorder (OCD), our knowledge of the long-term effects of this therapeutic option remains very limited. Objective: Our study aims to assess the long-term effectiveness and tolerability of DBS in OCD patients and to look for possible predictors of long-term response to this treatment. Methods: We studied the course of 25 patients with severe refractory OCD treated with DBS over an average follow-up period of 6.4 years (+/- 3.2) and compared them with a control group of 25 patients with severe OCD who refused DBS and maintained their usual treatment. DBS was implanted at the ventral anterior limb of the internal capsule and nucleus accumbens (vALIC-Nacc) in the first six patients and later at the bed nucleus of stria terminalis (BNST) in the rest of patients. Main outcome was change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score between the two groups assessed using mixed models. Secondary effectiveness outcomes included Hamilton Depression Rating Scale (HDRS) and Global Assessment of Functioning (GAF) scores. Results: Obsessive symptoms fell by 42.5% (Y-BOCS score) in patients treated with DBS and by 4.8% in the control group. Fifty-six per cent of DBS-treated patients could be considered responders at the end of follow-up and 28% partial responders. Two patients among those who rejected DBS were partial re-sponders (8%), but none of the non-DBS group achieved criteria for complete response. HDRS and GAF scores improved significantly in 39.2% and 43.6% among DBS-treated patients, while did not significantly change in those who rejected DBS (improvement limited to 6.2% in HDRS and 4.2% in GAF scores). No statistically significant predictors of response were found. Mixed models presented very large compar-ative effect sizes for DBS (4.29 for Y-BOCS, 1.15 for HDRS and 2.54 for GAF). Few patients experienced adverse effects and most of these effects were mild and transitory. Conclusions: The long-term comparative effectiveness and safety of DBS confirm it as a valid option for the treatment of severe refractory OCD.Elsevier BV2022info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/189123Articles 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/10.1016/j.brs.2022.07.050Brain Stimulation, 2022, vol. 15, núm. 5, p. 1128-1138https://doi.org/10.1016/j.brs.2022.07.050cc by-nc-nd (c) Mar Barrutia, Lorea et al., 2022http://creativecommons.org/licenses/by-nc-nd/3.0/es/info:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1891232026-05-27T06:46:51Z
dc.title.none.fl_str_mv Long-term comparative effectiveness of deep brain stimulation in severe obsessive-compulsive disorder
title Long-term comparative effectiveness of deep brain stimulation in severe obsessive-compulsive disorder
spellingShingle Long-term comparative effectiveness of deep brain stimulation in severe obsessive-compulsive disorder
Mar Barrutia, Lorea
Neurosi obsessiva
Efectes secundaris
Obsessive-compulsive disorder
Side effects
title_short Long-term comparative effectiveness of deep brain stimulation in severe obsessive-compulsive disorder
title_full Long-term comparative effectiveness of deep brain stimulation in severe obsessive-compulsive disorder
title_fullStr Long-term comparative effectiveness of deep brain stimulation in severe obsessive-compulsive disorder
title_full_unstemmed Long-term comparative effectiveness of deep brain stimulation in severe obsessive-compulsive disorder
title_sort Long-term comparative effectiveness of deep brain stimulation in severe obsessive-compulsive disorder
dc.creator.none.fl_str_mv Mar Barrutia, Lorea
Ibarrondo, Oliver
Mar, Javier
Real, Eva
Segalàs Cosi, Cinto
Bertolín Triquell, Sara
Aparicio, Marco Alberto
Plans, Gerard
Menchón Magriñá, José Manuel
Alonso, Pino
author Mar Barrutia, Lorea
author_facet Mar Barrutia, Lorea
Ibarrondo, Oliver
Mar, Javier
Real, Eva
Segalàs Cosi, Cinto
Bertolín Triquell, Sara
Aparicio, Marco Alberto
Plans, Gerard
Menchón Magriñá, José Manuel
Alonso, Pino
author_role author
author2 Ibarrondo, Oliver
Mar, Javier
Real, Eva
Segalàs Cosi, Cinto
Bertolín Triquell, Sara
Aparicio, Marco Alberto
Plans, Gerard
Menchón Magriñá, José Manuel
Alonso, Pino
author2_role author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Neurosi obsessiva
Efectes secundaris
Obsessive-compulsive disorder
Side effects
topic Neurosi obsessiva
Efectes secundaris
Obsessive-compulsive disorder
Side effects
description Background: Twenty years after the first use of Deep Brain Stimulation (DBS) in obsessive-compulsive disorder (OCD), our knowledge of the long-term effects of this therapeutic option remains very limited. Objective: Our study aims to assess the long-term effectiveness and tolerability of DBS in OCD patients and to look for possible predictors of long-term response to this treatment. Methods: We studied the course of 25 patients with severe refractory OCD treated with DBS over an average follow-up period of 6.4 years (+/- 3.2) and compared them with a control group of 25 patients with severe OCD who refused DBS and maintained their usual treatment. DBS was implanted at the ventral anterior limb of the internal capsule and nucleus accumbens (vALIC-Nacc) in the first six patients and later at the bed nucleus of stria terminalis (BNST) in the rest of patients. Main outcome was change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score between the two groups assessed using mixed models. Secondary effectiveness outcomes included Hamilton Depression Rating Scale (HDRS) and Global Assessment of Functioning (GAF) scores. Results: Obsessive symptoms fell by 42.5% (Y-BOCS score) in patients treated with DBS and by 4.8% in the control group. Fifty-six per cent of DBS-treated patients could be considered responders at the end of follow-up and 28% partial responders. Two patients among those who rejected DBS were partial re-sponders (8%), but none of the non-DBS group achieved criteria for complete response. HDRS and GAF scores improved significantly in 39.2% and 43.6% among DBS-treated patients, while did not significantly change in those who rejected DBS (improvement limited to 6.2% in HDRS and 4.2% in GAF scores). No statistically significant predictors of response were found. Mixed models presented very large compar-ative effect sizes for DBS (4.29 for Y-BOCS, 1.15 for HDRS and 2.54 for GAF). Few patients experienced adverse effects and most of these effects were mild and transitory. Conclusions: The long-term comparative effectiveness and safety of DBS confirm it as a valid option for the treatment of severe refractory OCD.
publishDate 2022
dc.date.none.fl_str_mv 2022
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/2445/189123
url https://hdl.handle.net/2445/189123
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/10.1016/j.brs.2022.07.050
Brain Stimulation, 2022, vol. 15, núm. 5, p. 1128-1138
https://doi.org/10.1016/j.brs.2022.07.050
dc.rights.none.fl_str_mv cc by-nc-nd (c) Mar Barrutia, Lorea et al., 2022
http://creativecommons.org/licenses/by-nc-nd/3.0/es/
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc by-nc-nd (c) Mar Barrutia, Lorea et al., 2022
http://creativecommons.org/licenses/by-nc-nd/3.0/es/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Elsevier BV
publisher.none.fl_str_mv Elsevier BV
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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score 15.300719

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