Molecular psychiatry · 2026
Comparative efficacy and safety of different surgical strategies for refractory obsessive-compulsive disorder: evidence from network meta-analysis.
СтатьяNetwork Meta-AnalysisСравнительное исследованиеСистематический обзорНазвание и аннотация: Перевод пока не подготовлен
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Xue Tao, Qiu Youjia, Li Xianze, Xie Minjia, Wang Wei, Chen Zhouqing, Xie Hutao, Bai Yutong, Yang Anchao, Meng Fangang, Wang Zhong, Zhang Jianguo
Аннотация
OBJECTIVE: To conduct a network meta-analysis to compare the efficacy and safety of various surgical strategies for refractory obsessive-compulsive disorder (OCD), including ablative surgery (ABL) and deep brain stimulation (DBS), with the aim to guide clinical treatment.
METHODS: We searched major electronic databases for different surgical interventions of OCD. The primary outcomes were changes in the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at 1 year and at the longest follow-up (LFU); the secondary outcomes included responder rates of Y-BOCS (≥35% reduction) and changes in global function, depression, and anxiety; and the safety outcomes included surgery-related adverse events (SRAEs) and serious adverse events (SAEs).
RESULTS: A total of 75 studies involving 1259 patients and 20 surgical strategies were enrolled. Most interventions resulted in significant improvements in Y-BOCS scores, with a reduction of around 10-15 points. Among them, radiofrequency capsulotomy (RF-Cap, mean difference [MD]: 17.251 at 1 year; MD: 17.458 at LFU) and inferior thalamic peduncle DBS (ITP-DBS, MD: 18.126 at 1 year; MD: 20.209 at LFU) were associated with the greatest improvements. Subthalamic nucleus + ventral capsule/ventral striatum DBS (STN + VC/VS-DBS) also exhibited good efficacy at the LFU (MD: 20.780), although data were lacking at 1 year. In terms of safety, ABL was associated with a higher rate of SRAEs than DBS (26 VS. 22%, p = 0.0325), with mechanical-Cap exhibiting the highest SRAE rate (47.5%). However, both DBS and ABL showed good acceptability, with no significant difference in SAEs.
CONCLUSION: Based on the current analysis, RF-Cap and ITP-DBS were associated with the largest improvements; however, the evidence for ITP-DBS is based on a small sample size, and should therefore be interpreted with caution. More head-to-head studies are needed to directly compare different surgical techniques and identify individual treatment options.
METHODS: We searched major electronic databases for different surgical interventions of OCD. The primary outcomes were changes in the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at 1 year and at the longest follow-up (LFU); the secondary outcomes included responder rates of Y-BOCS (≥35% reduction) and changes in global function, depression, and anxiety; and the safety outcomes included surgery-related adverse events (SRAEs) and serious adverse events (SAEs).
RESULTS: A total of 75 studies involving 1259 patients and 20 surgical strategies were enrolled. Most interventions resulted in significant improvements in Y-BOCS scores, with a reduction of around 10-15 points. Among them, radiofrequency capsulotomy (RF-Cap, mean difference [MD]: 17.251 at 1 year; MD: 17.458 at LFU) and inferior thalamic peduncle DBS (ITP-DBS, MD: 18.126 at 1 year; MD: 20.209 at LFU) were associated with the greatest improvements. Subthalamic nucleus + ventral capsule/ventral striatum DBS (STN + VC/VS-DBS) also exhibited good efficacy at the LFU (MD: 20.780), although data were lacking at 1 year. In terms of safety, ABL was associated with a higher rate of SRAEs than DBS (26 VS. 22%, p = 0.0325), with mechanical-Cap exhibiting the highest SRAE rate (47.5%). However, both DBS and ABL showed good acceptability, with no significant difference in SAEs.
CONCLUSION: Based on the current analysis, RF-Cap and ITP-DBS were associated with the largest improvements; however, the evidence for ITP-DBS is based on a small sample size, and should therefore be interpreted with caution. More head-to-head studies are needed to directly compare different surgical techniques and identify individual treatment options.