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Deep brain stimulation for obsessive–compulsive disorder: a systematic review and meta-analysis

Published online by Cambridge University Press:  25 April 2014

S. Kisely ,
K. Hall ,
D. Siskind ,
J. Frater ,
S. Olson  and
D. Crompton
S. Kisely*
Affiliation:
The University of Queensland Rural Clinical School, QLD, Australia Metro South Health Service, Woolloongabba, QLD, Australia Griffith Institute of Health, Griffith University, QLD, Australia Diamantina Health Partners, QLD, Australia
K. Hall
Affiliation:
The University of Queensland Rural Clinical School, QLD, Australia
D. Siskind
Affiliation:
Metro South Health Service, Woolloongabba, QLD, Australia Diamantina Health Partners, QLD, Australia
J. Frater
Affiliation:
Metro South Health Service, Woolloongabba, QLD, Australia
S. Olson
Affiliation:
Metro South Health Service, Woolloongabba, QLD, Australia
D. Crompton
Affiliation:
Metro South Health Service, Woolloongabba, QLD, Australia Diamantina Health Partners, QLD, Australia
*
*Address for correspondence: Dr S. Kisely, School of Medicine, The University of Queensland, Level 4, Building 1, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102, Australia. (Email: s.kisely@uq.edu.au)
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Abstract

Background.

Deep brain stimulation (DBS) is increasingly being applied to psychiatric conditions such as obsessive–compulsive disorder (OCD), major depression and anorexia nervosa. Double-blind, randomized controlled trials (RCTs) of active versus sham treatment have been limited to small numbers. We therefore undertook a systematic review and meta-analysis of the effectiveness of DBS in psychiatric conditions to maximize study power.

Method.

We conducted a systematic literature search for double-blind, RCTs of active versus sham treatment using Pubmed/Medline and EMBASE up to April 2013. Where possible, we combined results from studies in a meta-analysis. We assessed differences in final values between the active and sham treatments for parallel-group studies and compared changes from baseline score for cross-over designs.

Results.

Inclusion criteria were met by five studies, all of which were of OCD. Forty-four subjects provided data for the meta-analysis. The main outcome was a reduction in obsessive symptoms as measured by the Yale–Brown Obsessive Compulsive Scale (YBOCS). Patients on active, as opposed to sham, treatment had a significantly lower mean score [mean difference (MD) −8.93, 95% confidence interval (CI) −13.35 to −5.76, p < 0.001], representing partial remission. However, one-third of patients experienced significant adverse effects (n = 16). There were no differences between the two groups in terms of other outcomes.

Conclusions.

DBS may show promise for treatment-resistant OCD but there are insufficient randomized controlled data for other psychiatric conditions. DBS remains an experimental treatment in adults for severe, medically refractory conditions until further data are available.

Keywords

Deep brain stimulationmeta-analysisneurosurgeryobsessive-compulsive disorderYBOCS
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 16 , December 2014 , pp. 3533 - 3542
Copyright
Copyright © Cambridge University Press 2014 

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References

Abelson, JL, Curtis, GC, Sagher, O, Albucher, RC, Harrigan, M, Taylor, SF, Martis, B, Giordani, B (2005). Deep brain stimulation for refractory obsessive-compulsive disorder. Biological Psychiatry 57, 510–516.Google Scholar
Abramowitz, JS, Taylor, S, McKay, D (2009). Obsessive-compulsive disorder. Lancet 374, 491–499.CrossRefGoogle ScholarPubMed
Aouizerate, B, Rotgé, J-Y, Martin-Guehl, C, Cuny, E, Rougier, A, Guehl, D, Burbaud, P, Bioulac, B, Tignol, J (2006). A systematic review of psychosurgical treatments for obsessive-compulsive disorder: does deep brain stimulation represent the future trend in psychosurgery. Clinical Neuropsychiatry 3, 391–403.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. DSM-IV-TR. American Psychiatric Association: Washington, DC.Google Scholar
Benabid, AL, Pollak, P, Gervason, C, Hoffmann, D, Gao, DM, Hommel, M, Perret, JE, de Rougemont, J (1991). Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus. Lancet 337, 403–406.Google Scholar
Benazzouz, A, Piallat, B, Pollak, P, Benabid, AL (1995). Responses of substantia nigra pars reticulata and globus pallidus complex to high frequency stimulation of the subthalamic nucleus in rats: electrophysiological data. Neuroscience Letters 189, 77–80.CrossRefGoogle ScholarPubMed
Bittar, RG, Kar-Purkayastha, I, Owen, SL, Bear, RE, Green, A, Wang, S, Aziz, TZ (2005). Deep brain stimulation for pain relief: a meta-analysis. Journal of Clinical Neuroscience 12, 515–519.Google Scholar
Bloch, MH, Landeros-Weisenberger, A, Kelmendi, B, Coric, V, Bracken, MB, Leckman, JF (2006). A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Molecular Psychiatry 11, 622–632.Google Scholar
Cho, DY, Lee, WY, Chen, CC (2008). Limbic leukotomy for intractable major affective disorders, a 7-year follow-up study using nine comprehensive psychiatric test evaluations. Journal of Clinical Neuroscience 15, 138–142.CrossRefGoogle ScholarPubMed
D'Astous, M, Cottin, S, Roy, M, Picard, C, Cantin, L (2013). Bilateral stereotactic anterior capsulotomy for obsessive-compulsive disorder, long-term follow-up. Journal of Neurology, Neurosurgery and Psychiatry 84, 1208–1213.Google Scholar
de Koning, PP, Figee, M, van den Munckhof, P, Schuurman, PR, Denys, D (2011). Current status of deep brain stimulation for obsessive-compulsive disorder: a clinical review of different targets. Current Psychiatry Reports 13, 274–282.Google Scholar
Denys, D, Mantione, M, Figee, M, van den Munckhof, P, Koerselman, F, Westenberg, H, Bosch, A, Schuurman, R (2010). Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Archives of General Psychiatry 67, 1061–1068.CrossRefGoogle ScholarPubMed
Goodman, WK, Foote, KD, Greenberg, BD, Ricciuti, N, Bauer, R, Ward, H, Shapira, NA, Wu, SS, Hill, CL, Rasmussen, SA, Okun, MS (2010). Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, staggered-onset design. Biological Psychiatry 67, 535–542.CrossRefGoogle ScholarPubMed
Greenberg, BD, Gabriels, LA, Malone, DA Jr, Rezai, AR, Friehs, GM, Okun, MS, Shapira, NA, Foote, KD, Cosyns, PR, Kubu, CS, Malloy, PF, Salloway, SP, Giftakis, JE, Rise, MT, Machado, AG, Baker, KB, Stypulkowski, PH, Goodman, WK, Rasmussen, SA, Nuttin, BJ (2010). Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Molecular Psychiatry 15, 64–79.Google Scholar
Grimley Evans, J, Malouf, R, Huppert, F, van Niekerk, JK (2006). Dehydroepiandrosterone (DHEA) supplementation for cognitive function in healthy elderly people. Cochrane Database of Systematic Reviews. Issue 4, Art. No. CD006221.CrossRefGoogle ScholarPubMed
Hariz, MI, Hariz, GM (2013). Therapeutic stimulation versus ablation. Handbook of Clinical Neurology 116, 63–71.Google Scholar
Higgins, JPT, Green, S (eds) (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration.Google Scholar
Holloway, KL, Baron, MS, Brown, R, Cifu, DX, Carne, W, Ramakrishnan, V (2006). Deep brain stimulation for dystonia: a meta-analysis. Neuromodulation 9, 253–261.CrossRefGoogle ScholarPubMed
Holtzheimer, PE, Kelley, ME, Gross, RE, Filkowski, MM, Garlow, SJ, Barrocas, A, Wint, D, Craighead, MC, Kozarsky, J, Chismar, R, Moreines, JL, Mewes, K, Posse, PR, Gutman, DA, Mayberg, HS (2012). Subcallosal cingulate deep brain stimulation for treatment-resistant unipolar and bipolar depression. Archives of General Psychiatry 69, 150–158.CrossRefGoogle ScholarPubMed
Iremonger, KJ, Anderson, TR, Hu, B, Kiss, ZH (2006). Cellular mechanisms preventing sustained activation of cortex during subcortical high-frequency stimulation. Journal of Neurophysiology 96, 613–621.CrossRefGoogle ScholarPubMed
Jung, HH, Kim, CH, Chang, JH, Park, YG, Chung, SS, Chang, JW (2006). Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: long-term follow-up results. Stereotactic and Functional Neurosurgery 84, 184–189.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Demler, O, Jin, R, Merikangas, KR, Walters, EE (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 593–602.Google Scholar
Kleiner-Fisman, G, Herzog, J, Fisman, DN, Tamma, F, Lyons, KE, Pahwa, R, Lang, AE, Deuschl, G (2006). Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Movement Disorders 21 (Suppl. 14), S290–S304.CrossRefGoogle ScholarPubMed
Kringelbach, ML, Aziz, TZ (2009). Deep brain stimulation: avoiding the errors of psychosurgery. Journal of the American Medical Association 301, 1705–1707.CrossRefGoogle ScholarPubMed
Kubu, CS, Malone, DA, Chelune, G, Malloy, P, Rezai, AR, Frazier, T, Machado, A, Rasmussen, S, Friehs, G, Greenberg, BD (2013). Neuropsychological outcome after deep brain stimulation in the ventral capsule/ventral striatum for highly refractory obsessive-compulsive disorder or major depression. Stereotactic and Functional Neurosurgery 91, 374–378.Google Scholar
Loo, C, Trollor, J, Alonzo, A, Rendina, N, Kavess, R (2010). Mental health legislation and psychiatric treatments in NSW: electroconvulsive therapy and deep brain stimulation. Australasian Psychiatry 18, 417–425.CrossRefGoogle ScholarPubMed
Lozano, AM, Mayberg, HS, Giacobbe, P, Hamani, C, Craddock, RC, Kennedy, SH (2008). Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression. Biological Psychiatry 64, 461–467.Google Scholar
Mallet, L, Polosan, M, Jaafari, N, Baup, N, Welter, ML, Fontaine, D, du Montcel, ST, Yelnik, J, Chereau, I, Arbus, C, Raoul, S, Aouizerate, B, Damier, P, Chabardes, S, Czernecki, V, Ardouin, C, Krebs, MO, Bardinet, E, Chaynes, P, Burbaud, P, Cornu, P, Derost, P, Bougerol, T, Bataille, B, Mattei, V, Dormont, D, Devaux, B, Verin, M, Houeto, JL, Pollak, P, Benabid, AL, Agid, Y, Krack, P, Millet, B, Pelissolo, A (2008). Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. New England Journal of Medicine 359, 2121–2134.Google Scholar
McIntyre, CC, Savasta, M, Kerkerian-Le, Goff L, Vitek, JL (2004). Uncovering the mechanism(s) of action of deep brain stimulation: activation, inhibition, or both. Clinical Neurophysiology 115, 1239–1248.CrossRefGoogle ScholarPubMed
Medtronic (2014). About Deep Brain Stimulation for Psychiatric Disorders (https://professional.medtronic.com/pt/neuro/dbs-pd/edu/about/index.htm#tabs-1). Accessed 19 March 2014.Google Scholar
Nuttin, BJ, Gabriels, LA, Cosyns, PR, Meyerson, BA, Andreewitch, S, Sunaert, SG, Maes, AF, Dupont, PJ, Gybels, JM, Gielen, F, Demeulemeester, HG (2003). Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder. Neurosurgery 52, 1263–1272; discussion 1272–1274.CrossRefGoogle ScholarPubMed
Parsons, TD, Rogers, SA, Braaten, AJ, Woods, SP, Tröster, AI (2006). Cognitive sequelae of subthalamic nucleus deep brain stimulation in Parkinson's disease: a meta-analysis. Lancet Neurology 5, 578–588.Google Scholar
Perlmutter, JS, Mink, JW (2006). Deep brain stimulation. Annual Review of Neuroscience 29, 229–257.CrossRefGoogle ScholarPubMed
Schlaepfer, TE, Bewernick, BH (2013). Deep brain stimulation for major depression. Handbook of Clinical Neurology 116, 235–243.Google Scholar
Schlaepfer, TE, Lieb, K (2005). Deep brain stimulation for treatment of refractory depression. Lancet 366, 1420–1422.CrossRefGoogle ScholarPubMed
Shah, DB, Pesiridou, A, Baltuch, GH, Malone, DA, O'Reardon, JP (2008). Functional neurosurgery in the treatment of severe obsessive compulsive disorder and major depression: overview of disease circuits and therapeutic targeting for the clinician. Psychiatry (Edgmont) 5, 24–33.Google Scholar
Torres, AR, Prince, MJ, Bebbington, PE, Bhugra, D, Brugha, TS, Farrell, M, Jenkins, R, Lewis, G, Meltzer, H, Singleton, N (2006). Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. American Journal of Psychiatry 163, 1978–1985.CrossRefGoogle ScholarPubMed
Wu, H, Van Dyck-Lippens, PJ, Santegoeds, R, van Kuyck, K, Gabriels, L, Lin, G, Pan, G, Li, Y, Li, D, Zhan, S, Sun, B, Nuttin, B (2013). Deep-brain stimulation for anorexia nervosa. World Neurosurgery 80, S29.e1–S29.e10.Google Scholar