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Deep brain stimulation for obsessive–compulsive disorder: a systematic review and meta-analysis

Published online by Cambridge University Press:  25 April 2014

S. Kisely ,
K. Hall ,
D. Siskind ,
J. Frater ,
S. Olson  and
D. Crompton
S. Kisely*
Affiliation:
The University of Queensland Rural Clinical School, QLD, Australia Metro South Health Service, Woolloongabba, QLD, Australia Griffith Institute of Health, Griffith University, QLD, Australia Diamantina Health Partners, QLD, Australia
K. Hall
Affiliation:
The University of Queensland Rural Clinical School, QLD, Australia
D. Siskind
Affiliation:
Metro South Health Service, Woolloongabba, QLD, Australia Diamantina Health Partners, QLD, Australia
J. Frater
Affiliation:
Metro South Health Service, Woolloongabba, QLD, Australia
S. Olson
Affiliation:
Metro South Health Service, Woolloongabba, QLD, Australia
D. Crompton
Affiliation:
Metro South Health Service, Woolloongabba, QLD, Australia Diamantina Health Partners, QLD, Australia
*
* Address for correspondence: Dr S. Kisely, School of Medicine, The University of Queensland, Level 4, Building 1, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102, Australia. (Email: [email protected])
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Abstract

Background.

Deep brain stimulation (DBS) is increasingly being applied to psychiatric conditions such as obsessive–compulsive disorder (OCD), major depression and anorexia nervosa. Double-blind, randomized controlled trials (RCTs) of active versus sham treatment have been limited to small numbers. We therefore undertook a systematic review and meta-analysis of the effectiveness of DBS in psychiatric conditions to maximize study power.

Method.

We conducted a systematic literature search for double-blind, RCTs of active versus sham treatment using Pubmed/Medline and EMBASE up to April 2013. Where possible, we combined results from studies in a meta-analysis. We assessed differences in final values between the active and sham treatments for parallel-group studies and compared changes from baseline score for cross-over designs.

Results.

Inclusion criteria were met by five studies, all of which were of OCD. Forty-four subjects provided data for the meta-analysis. The main outcome was a reduction in obsessive symptoms as measured by the Yale–Brown Obsessive Compulsive Scale (YBOCS). Patients on active, as opposed to sham, treatment had a significantly lower mean score [mean difference (MD) −8.93, 95% confidence interval (CI) −13.35 to −5.76, p < 0.001], representing partial remission. However, one-third of patients experienced significant adverse effects (n = 16). There were no differences between the two groups in terms of other outcomes.

Conclusions.

DBS may show promise for treatment-resistant OCD but there are insufficient randomized controlled data for other psychiatric conditions. DBS remains an experimental treatment in adults for severe, medically refractory conditions until further data are available.

Keywords

Deep brain stimulationmeta-analysisneurosurgeryobsessive-compulsive disorderYBOCS
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 16 , December 2014 , pp. 3533 - 3542
Copyright
Copyright © Cambridge University Press 2014 

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