Javier Vázquez-Bourgon1, Juan Martino2, María Sierra Peña3, Jon Infante Ceberio4, M Ángeles Martínez Martínez5, Roberto Ocón5, José Manuel Menchón6, Benedicto Crespo Facorro7, Alfonso Vázquez-Barquero2. 1. Servicio de Psiquiatría, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Centro de Investigación en Red de Salud Mental (CIBERSAM), Santander, España; Unidad de Estimulación Cerebral Profunda, Hospital Universitario Marqués de Valdecilla, Santander, España. Electronic address: javazquez@humv.es. 2. Servicio de Neurocirugía, Hospital Universitario Marqués de Valdecilla, Santander, España; Unidad de Estimulación Cerebral Profunda, Hospital Universitario Marqués de Valdecilla, Santander, España. 3. Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, España; Unidad de Estimulación Cerebral Profunda, Hospital Universitario Marqués de Valdecilla, Santander, España. 4. Servicio de Neurología, Hospital Universitario Marqués de Valdecilla, Santander, España; Centro de Investigación en Red de Enfermedades Neurodegenerativas (CIBERNED), Universidad de Cantabria, Santander, España; Unidad de Estimulación Cerebral Profunda, Hospital Universitario Marqués de Valdecilla, Santander, España. 5. Servicio de Neurofisiología, Hospital Universitario Marqués de Valdecilla, Santander, España; Unidad de Estimulación Cerebral Profunda, Hospital Universitario Marqués de Valdecilla, Santander, España. 6. Unidad Clínica y de Investigación en TOC, Departamento de Psiquiatría, Hospital de Bellvitge, Instituto de Investigación Biomédica Bellvitge-IDIBELL, Centro de Investigación en Red de Salud Mental (CIBERSAM), Departamento de Ciencias Clínicas, Universidad de Barcelona, Barcelona, España. 7. Servicio de Psiquiatría, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Centro de Investigación en Red de Salud Mental (CIBERSAM), Santander, España.
Abstract
INTRODUCTION: At least 10% of patients with Obsessive-compulsive Disorder (OCD) are refractory to psychopharmacological treatment. The emergence of new technologies for the modulation of altered neuronal activity in Neurosurgery, deep brain stimulation (DBS), has enabled its use in severe and refractory OCD cases. The objective of this article is to review the current scientific evidence on the effectiveness and applicability of this technique to refractory OCD. METHOD: We systematically reviewed the literature to identify the main characteristics of deep brain stimulation, its use and applicability as treatment for obsessive-compulsive disorder. Therefore, we reviewed PubMed/Medline, Embase and PsycINFO databases, combining the key-words 'Deep brain stimulation', 'DBS' and 'Obsessive-compulsive disorder' 'OCS'. The articles were selected by two of the authors independently, based on the abstracts, and if they described any of the main characteristics of the therapy referring to OCD: applicability; mechanism of action; brain therapeutic targets; efficacy; side-effects; co-therapies. All the information was subsequently extracted and analysed. RESULTS: The critical analysis of the evidence shows that the use of DBS in treatment-resistant OCD is providing satisfactory results regarding efficacy, with assumable side-effects. However, there is insufficient evidence to support the use of any single brain target over another. Patient selection has to be done following analyses of risks/benefits, being advisable to individualize the decision of continuing with concomitant psychopharmacological and psychological treatments. CONCLUSIONS: The use of DBS is still considered to be in the field of research, although it is increasingly used in refractory-OCD, producing in the majority of studies significant improvements in symptomatology, and in functionality and quality of life. It is essential to implement random and controlled studies regarding its long-term efficacy, cost-risk analyses and cost/benefit.
INTRODUCTION: At least 10% of patients with Obsessive-compulsive Disorder (OCD) are refractory to psychopharmacological treatment. The emergence of new technologies for the modulation of altered neuronal activity in Neurosurgery, deep brain stimulation (DBS), has enabled its use in severe and refractory OCD cases. The objective of this article is to review the current scientific evidence on the effectiveness and applicability of this technique to refractory OCD. METHOD: We systematically reviewed the literature to identify the main characteristics of deep brain stimulation, its use and applicability as treatment for obsessive-compulsive disorder. Therefore, we reviewed PubMed/Medline, Embase and PsycINFO databases, combining the key-words 'Deep brain stimulation', 'DBS' and 'Obsessive-compulsive disorder' 'OCS'. The articles were selected by two of the authors independently, based on the abstracts, and if they described any of the main characteristics of the therapy referring to OCD: applicability; mechanism of action; brain therapeutic targets; efficacy; side-effects; co-therapies. All the information was subsequently extracted and analysed. RESULTS: The critical analysis of the evidence shows that the use of DBS in treatment-resistant OCD is providing satisfactory results regarding efficacy, with assumable side-effects. However, there is insufficient evidence to support the use of any single brain target over another. Patient selection has to be done following analyses of risks/benefits, being advisable to individualize the decision of continuing with concomitant psychopharmacological and psychological treatments. CONCLUSIONS: The use of DBS is still considered to be in the field of research, although it is increasingly used in refractory-OCD, producing in the majority of studies significant improvements in symptomatology, and in functionality and quality of life. It is essential to implement random and controlled studies regarding its long-term efficacy, cost-risk analyses and cost/benefit.
Authors: Andrew Guzick; Patrick J Hunt; Kelly R Bijanki; Sophie C Schneider; Sameer A Sheth; Wayne K Goodman; Eric A Storch Journal: Expert Rev Neurother Date: 2019-11-22 Impact factor: 4.618
Authors: Harish RaviPrakash; Milena Korostenskaja; Eduardo M Castillo; Ki H Lee; Christine M Salinas; James Baumgartner; Syed M Anwar; Concetto Spampinato; Ulas Bagci Journal: Front Neurosci Date: 2020-05-06 Impact factor: 4.677