Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?
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Wu Hemmings, Hariz Marwan, Visser-Vandewalle Veerle, Zrinzo Ludvic, Coenen Volker A, Sheth Sameer A, Bervoets Chris, Naesström Matilda, Blomstedt Patric, Coyne Terry, Hamani Clement, Slavin Konstantin, Krauss Joachim K, Kahl Kai G, Taira Takaomi, Zhang Chencheng, Sun Bomin, Toda Hiroki, Schlaepfer Thomas, Chang Jin Woo, Régis Jean, Schuurman Rick, Schulder Michael, Doshi Paresh, Mosley Philip, Poologaindran Anujan, Lázaro-Muñoz Gabriel, Pepper Joshua, Schechtmann Gaston, Fytagoridis Anders, Huys Daniel, Gonçalves-Ferreira Antonio, D'Haese Pierre-François, Neimat Joseph, Broggi Giovanni, Vilela-Filho Osvaldo, Voges Jürgen, Alkhani Ahmed, Nakajima Takeshi, Richieri Raphaelle, Djurfeldt Diana, Fontaine Philippe, Martinez-Alvarez Roberto, Okamura Yasushi, Chandler Jennifer, Watanabe Katsushige, Barcia Juan A, Reneses Blanca, Lozano Andres, Gabriëls Loes, De Salles Antonio, Halpern Casey H, Matthews Keith, Fins Joseph J, Nuttin Bart
Аннотация
A consensus has yet to emerge whether deep brain stimulation (DBS) for treatment-refractory obsessive-compulsive disorder (OCD) can be considered an established therapy. In 2014, the World Society for Stereotactic and Functional Neurosurgery (WSSFN) published consensus guidelines stating that a therapy becomes established when "at least two blinded randomized controlled clinical trials from two different groups of researchers are published, both reporting an acceptable risk-benefit ratio, at least comparable with other existing therapies. The clinical trials should be on the same brain area for the same psychiatric indication." The authors have now compiled the available evidence to make a clear statement on whether DBS for OCD is established therapy. Two blinded randomized controlled trials have been published, one with level I evidence (Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score improved 37% during stimulation on), the other with level II evidence (25% improvement). A clinical cohort study (N = 70) showed 40% Y-BOCS score improvement during DBS, and a prospective international multi-center study 42% improvement (N = 30). The WSSFN states that electrical stimulation for otherwise treatment refractory OCD using a multipolar electrode implanted in the ventral anterior capsule region (including bed nucleus of stria terminalis and nucleus accumbens) remains investigational. It represents an emerging, but not yet established therapy. A multidisciplinary team involving psychiatrists and neurosurgeons is a prerequisite for such therapy, and the future of surgical treatment of psychiatric patients remains in the realm of the psychiatrist.