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

Area of Science:

• Neurosurgery
• Psychiatry
• Neurology

Background:

• Deep brain stimulation (DBS) is being explored for treatment-refractory obsessive-compulsive disorder (OCD).
• The World Society for Stereotactic and Functional Neurosurgery (WSSFN) established criteria for therapy establishment in 2014.

Purpose of the Study:

• To evaluate whether DBS for OCD meets the criteria for an established therapy.
• To compile and assess existing evidence on DBS for OCD.

Main Methods:

• Review of published blinded randomized controlled trials (RCTs) and clinical studies on DBS for OCD.
• Assessment of evidence levels (Level I and II) and reported outcomes (Yale-Brown Obsessive Compulsive Scale - Y-BOCS scores).

Main Results:

• Two blinded RCTs (Level I and II) reported Y-BOCS score improvements of 37% and 25%.
• Clinical studies (N=70 and N=30) showed Y-BOCS score improvements of 40% and 42% respectively.
• The WSSFN classifies DBS for OCD as investigational, not established.

Conclusions:

• DBS for treatment-refractory OCD remains an emerging therapy.
• It requires a multidisciplinary team approach involving psychiatrists and neurosurgeons.
• Future psychiatric surgical treatments depend on psychiatric expertise.