Deep brain stimulation versus ablative surgery for treatment-refractory obsessive-compulsive disorder: A...

Area of Science:

• Neurosurgery
• Psychiatry
• Medical Statistics

Background:

• Ablative surgery (ABL) and deep brain stimulation (DBS) are established last-resort treatments for treatment-refractory obsessive-compulsive disorder (OCD).
• Comparative efficacy and safety data between these modalities are crucial for clinical decision-making.

Purpose of the Study:

• To conduct an updated meta-analysis comparing the clinical outcomes of ablative procedures (capsulotomy, cingulotomy) and deep brain stimulation for refractory OCD.
• To evaluate the efficacy and adverse event profiles of ABL versus DBS.

Main Methods:

• A systematic PubMed search identified clinical trials on capsulotomy, cingulotomy, and DBS for refractory OCD.
• Random effects meta-analyses were performed on 38 articles, focusing on Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction and responder rates (≥35% Y-BOCS reduction).

Main Results:

• Both ABL and DBS demonstrated significant efficacy in treating refractory OCD, with comparable responder rates (48-57%) and large effect sizes for Y-BOCS score reduction.
• Meta-regression revealed no statistically significant difference in efficacy between ABL and DBS.
• Deep brain stimulation (DBS) was associated with a statistically significant higher rate of impulsivity compared to ablative surgery (ABL).

Conclusions:

• Ablative surgery (ABL) and deep brain stimulation (DBS) exhibit equal efficacy for treating refractory obsessive-compulsive disorder (OCD).
• Treatment choice should consider factors like impulsivity risk, patient preference, and surgeon expertise.
• Further research with direct comparisons is needed to personalize treatment selection between ABL and DBS.