PMID- 34631467 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20211012 IS - 2220-3206 (Print) IS - 2220-3206 (Electronic) IS - 2220-3206 (Linking) VI - 11 IP - 9 DP - 2021 Sep 19 TI - Deep brain stimulation for obsessive-compulsive disorder: A systematic review of worldwide experience after 20 years. PG - 659-680 LID - 10.5498/wjp.v11.i9.659 [doi] AB - BACKGROUND: Twenty years after its first use in a patient with obsessive-compulsive disorder (OCD), the results confirm that deep brain stimulation (DBS) is a promising therapy for patients with severe and resistant forms of the disorder. Nevertheless, many unknowns remain, including the optimal anatomical targets, the best stimulation parameters, the long-term (LT) effects of the therapy, and the clinical or biological factors associated with response. This systematic review of the articles published to date on DBS for OCD assesses the short and LT efficacy of the therapy and seeks to identify predictors of response. AIM: To summarize the existing knowledge on the efficacy and tolerability of DBS in treatment-resistant OCD. METHODS: A comprehensive search was conducted in the PubMed, Cochrane, Scopus, and ClinicalTrials.gov databases from inception to December 31, 2020, using the following strategy: "(Obsessive-compulsive disorder OR OCD) AND (deep brain stimulation OR DBS)." Clinical trials and observational studies published in English and evaluating the effectiveness of DBS for OCD in humans were included and screened for relevant information using a standardized collection tool. The inclusion criteria were as follows: a main diagnosis of OCD, DBS conducted for therapeutic purposes and variation in symptoms of OCD measured by the Yale-Brown Obsessive-Compulsive scale (Y-BOCS) as primary outcome. Data were analyzed with descriptive statistics. RESULTS: Forty articles identified by the search strategy met the eligibility criteria. Applying a follow-up threshold of 36 mo, 29 studies (with 230 patients) provided information on short-term (ST) response to DBS in, while 11 (with 155 patients) reported results on LT response. Mean follow-up period was 18.5 +/- 8.0 mo for the ST studies and 63.7 +/- 20.7 mo for the LT studies. Overall, the percentage of reduction in Y-BOCS scores was similar in ST (47.4%) and LT responses (47.2%) to DBS, but more patients in the LT reports met the criteria for response (defined as a reduction in Y-BOCS scores > 35%: ST, 60.6% vs LT, 70.7%). According to the results, the response in the first year predicts the extent to which an OCD patient will benefit from DBS, since the maximum symptom reduction was achieved in most responders in the first 12-14 mo after implantation. Reports indicate a consistent tendency for this early improvement to be maintained to the mid-term for most patients; but it is still controversial whether this improvement persists, increases or decreases in the long term. Three different patterns of LT response emerged from the analysis: 49.5% of patients had good and sustained response to DBS, 26.6% were non responders, and 22.5% were partial responders, who might improve at some point but experience relapses during follow-up. A significant improvement in depressive symptoms and global functionality was observed in most studies, usually (although not always) in parallel with an improvement in obsessive symptoms. Most adverse effects of DBS were mild and transient and improved after adjusting stimulation parameters; however, some severe adverse events including intracranial hemorrhages and infections were also described. Hypomania was the most frequently reported psychiatric side effect. The relationship between DBS and suicide risk is still controversial and requires further study. Finally, to date, no clear clinical or biological predictors of response can be established, probably because of the differences between studies in terms of the neuroanatomical targets and stimulation protocols assessed. CONCLUSION: The present review confirms that DBS is a promising therapy for patients with severe resistant OCD, providing both ST and LT evidence of efficacy. CI - (c)The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved. FAU - Mar-Barrutia, Lorea AU - Mar-Barrutia L AD - OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona 08907, Spain. FAU - Real, Eva AU - Real E AD - OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona 08907, Spain. FAU - Segalas, Cinto AU - Segalas C AD - OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona 08907, Spain. FAU - Bertolin, Sara AU - Bertolin S AD - OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona 08907, Spain. FAU - Menchon, Jose Manuel AU - Menchon JM AD - OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona 08907, Spain. FAU - Alonso, Pino AU - Alonso P AD - OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona 08907, Spain. LA - eng PT - Journal Article DEP - 20210919 PL - United States TA - World J Psychiatry JT - World journal of psychiatry JID - 101610480 PMC - PMC8474989 OTO - NOTNLM OT - Deep brain stimulation OT - Long-term OT - Obsessive-compulsive disorder OT - Predictors of response OT - Short-term OT - Side effects COIS- Conflict-of-interest statement: All the authors declare that they have no competing interests. EDAT- 2021/10/12 06:00 MHDA- 2021/10/12 06:01 PMCR- 2021/09/19 CRDT- 2021/10/11 06:07 PHST- 2021/02/28 00:00 [received] PHST- 2021/05/02 00:00 [revised] PHST- 2021/08/18 00:00 [accepted] PHST- 2021/10/11 06:07 [entrez] PHST- 2021/10/12 06:00 [pubmed] PHST- 2021/10/12 06:01 [medline] PHST- 2021/09/19 00:00 [pmc-release] AID - 10.5498/wjp.v11.i9.659 [doi] PST - epublish SO - World J Psychiatry. 2021 Sep 19;11(9):659-680. doi: 10.5498/wjp.v11.i9.659. eCollection 2021 Sep 19.