Bed nucleus of the stria terminalis deep brain stimulation in treatment-refractory obsessive-compulsive disorder: a systematic review.

BACKGROUND

Obsessive-compulsive disorder (OCD) is one of the most disabling psychiatric disorders. Despite the available pharmacological and psychotherapeutic treatments, symptoms persist to a severe degree in a large number of patients who are considered refractory to treatment. For some of them, deep brain stimulation (DBS) offers an appropriate therapeutic method. The purpose of this systematic review is to summarize the existing knowledge about the effectiveness of the stimulation of the bed nucleus of stria terminalis (BNST). MATERIALS AND

METHODS

A thorough literature review regarding BNST DBS for the treatment of OCD was conducted. The following sequence ‘’ (Obsessive-Compulsive Disorder) OR (OCD)) AND ((Deep Brain Stimulation) OR (DBS)) AND ((Bed Nucleus of Stria Terminalis) OR (BNST)) ‘’ was used when searching in the two databases, MEDLINE and Scopus.

RESULTS

In total, 8 studies were found after the application of the inclusion and exclusion criteria. Overall, 68 patients were included, with a mean age of surgery 41.2 years old. At the last follow-up, the mean reduction of the Yale-Brown Obsessive-Compulsive Scale (YBOCS) compared to baseline was 45.6% with a range across the studies of 38% to 53%. In total, 46 participants were considered responders. The median stimulation parameters were an amplitude of 4.7 V, a frequency of 130 Hz, and a pulse width of 129.2 µs. Finally, there was improvement of depressive and anxiety symptoms, as well as quality of life, without any significant cognitive impairment.

CONCLUSION

DBS of the BNST in treatment-refractory OCD appears as a safe and effective treatment option.