Predicting Response to vALIC Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder.

Area of Science:

• Neuroscience
• Psychiatry
• Neurosurgery

Background:

• Deep brain stimulation (DBS) is an effective but invasive treatment for refractory obsessive-compulsive disorder (OCD).
• Predicting patient response to DBS is crucial for optimizing resource allocation and managing expectations.
• Current clinical and demographic predictors for DBS in OCD lack robust evidence.

Purpose of the Study:

• To examine the association of baseline demographic and disease characteristics with treatment response to DBS in OCD patients.
• To identify reliable predictors for patient selection in ventral anterior limb of the internal capsule DBS (vALIC-DBS) for OCD.

Main Methods:

• Observational cohort study of 70 consecutive OCD patients undergoing vALIC-DBS.
• Analysis of baseline characteristics and 1-year symptom reduction using Fisher exact tests and logistic regression.
• Defined treatment response as >35% reduction in Yale-Brown Obsessive Compulsive Scale and 50% in Hamilton Depression Rating Scale scores.

Main Results:

• Insight into illness was the only significant predictor of individual response (PPV 84.4%, NPV 44.0%).
• Late-onset OCD correlated with greater symptom decrease, while comorbid personality disorder correlated with less decrease, but neither predicted vALIC-DBS response.
• While associated with outcomes, factors like age at onset, comorbid personality disorder, and insight were not sufficiently predictive for clinical patient selection.

Conclusions:

• Current clinical and demographic factors are insufficient to predict vALIC-DBS outcomes in OCD and should not exclude patients from treatment.
• These findings highlight the need for further research into predictive markers for vALIC-DBS in OCD.
• Avoid excluding patients based on factors like comorbid personality disorders, as predictive values are currently inadequate.