Deep Brain Stimulation for the Treatment of Treatment-Resistant Obsessive-Compulsive Disorder: A Meta-Analysis of Randomized Clinical Trials in 106 Patients.

Deep brain stimulation (DBS) is a new neuromodulatory treatment for treatment-resistant obsessive-compulsive disorder (OCD), but randomized controlled trials (RCTs) evidence remains sparse. We performed a systematic review and meta-analysis of 10 double-blind RCTs involving 106 patients, of which 59 were active DBS participants (PROSPERO CRD420251160997), to assess the efficacy and safety of DBS for the treatment of OCD. PubMed, Embase, and the Cochrane databases (through 2025) literature searches for studies comparing active (aDBS) with sham (sDBS) stimulation at the Y-BOCS–defined primary outcome. In blind phases combined across studies, Y-BOCS scores declined significantly with the comparison between active and sham DBS (mean difference [MD] = −5.58, 95% CI −8.13 to −3.02, P < 0.0001). They showed a larger percentage improvement in severity of symptoms (MD = 17.24%, 95% CI 10.64–23.84, P < 0.00001). In open-label extension periods, Y-BOCS scores declined by −13.05 points (95% CI −15.74 to −10.35, P < 0.00001). Side effects tended to be procedural and weak. These results represent the strongest controlled evidence to date that DBS provides meaningful improvement in severe treatment-resistant OCD and highlights the potential of DBS to modulate the cortico-striato-thalamo-cortical circuitry that is implicated in the disorder, emphasizing the necessity for large-scale harmonized trials to better define targets and optimize long-term outcomes.