PMID- 35926783
OWN - NLM
STAT- MEDLINE
DCOM- 20221018
LR  - 20221024
IS  - 1876-4754 (Electronic)
IS  - 1876-4754 (Linking)
VI  - 15
IP  - 5
DP  - 2022 Sep-Oct
TI  - Long-term comparative effectiveness of deep brain stimulation in severe 
      obsessive-compulsive disorder.
PG  - 1128-1138
LID - S1935-861X(22)00170-X [pii]
LID - 10.1016/j.brs.2022.07.050 [doi]
AB  - BACKGROUND: Twenty years after the first use of Deep Brain Stimulation (DBS) in 
      obsessive-compulsive disorder (OCD), our knowledge of the long-term effects of 
      this therapeutic option remains very limited. OBJECTIVE: Our study aims to assess 
      the long-term effectiveness and tolerability of DBS in OCD patients and to look 
      for possible predictors of long-term response to this treatment. METHODS: We 
      studied the course of 25 patients with severe refractory OCD treated with DBS 
      over an average follow-up period of 6.4 years (+/-3.2) and compared them with a 
      control group of 25 patients with severe OCD who refused DBS and maintained their 
      usual treatment. DBS was implanted at the ventral anterior limb of the internal 
      capsule and nucleus accumbens (vALIC-Nacc) in the first six patients and later at 
      the bed nucleus of stria terminalis (BNST) in the rest of patients. Main outcome 
      was change in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score between the 
      two groups assessed using mixed models. Secondary effectiveness outcomes included 
      Hamilton Depression Rating Scale (HDRS) and Global Assessment of Functioning 
      (GAF) scores. RESULTS: Obsessive symptoms fell by 42.5% (Y-BOCS score) in 
      patients treated with DBS and by 4.8% in the control group. Fifty-six per cent of 
      DBS-treated patients could be considered responders at the end of follow-up and 
      28% partial responders. Two patients among those who rejected DBS were partial 
      responders (8%), but none of the non-DBS group achieved criteria for complete 
      response. HDRS and GAF scores improved significantly in 39.2% and 43.6% among 
      DBS-treated patients, while did not significantly change in those who rejected 
      DBS (improvement limited to 6.2% in HDRS and 4.2% in GAF scores). No 
      statistically significant predictors of response were found. Mixed models 
      presented very large comparative effect sizes for DBS (4.29 for Y-BOCS, 1.15 for 
      HDRS and 2.54 for GAF). Few patients experienced adverse effects and most of 
      these effects were mild and transitory. CONCLUSIONS: The long-term comparative 
      effectiveness and safety of DBS confirm it as a valid option for the treatment of 
      severe refractory OCD.
CI  - Copyright (c) 2022 The Authors. Published by Elsevier 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, Spain; Department of Psychiatry, Osakidetza Basque Health Service, 
      Araba University Hospital, Vitoria-Gasteiz, Spain.
FAU - Ibarrondo, Oliver
AU  - Ibarrondo O
AD  - Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, 
      Research Unit, Arrasate-Mondragon, Spain.Biodonostia Health Research Institute, 
      Donostia-San Sebastian, Spain; Kronikgune Institute for Health Services Research, 
      Barakaldo, Spain.
FAU - Mar, Javier
AU  - Mar J
AD  - Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, 
      Research Unit, Arrasate-Mondragon, Spain.Biodonostia Health Research Institute, 
      Donostia-San Sebastian, Spain; Kronikgune Institute for Health Services Research, 
      Barakaldo, Spain; Biodonostia Health Research Institute, Donostia-San Sebastian, 
      Spain.
FAU - Real, Eva
AU  - Real E
AD  - OCD Clinical and Research Unit. Department of Psychiatry, Hospital de Bellvitge, 
      Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, 
      Spain; CIBERSAM (Centro de Investigacion en Red de Salud Mental), Carlos III 
      Health Institute, Madrid, Spain.
FAU - Segalas, Cinto
AU  - Segalas C
AD  - OCD Clinical and Research Unit. Department of Psychiatry, Hospital de Bellvitge, 
      Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, 
      Spain; CIBERSAM (Centro de Investigacion en Red de Salud Mental), Carlos III 
      Health Institute, Madrid, Spain; Department of Clinical Sciences, Faculty of 
      Medicine, University of Barcelona, Spain.
FAU - Bertolin, Sara
AU  - Bertolin S
AD  - OCD Clinical and Research Unit. Department of Psychiatry, Hospital de Bellvitge, 
      Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, 
      Spain.
FAU - Aparicio, Marco Alberto
AU  - Aparicio MA
AD  - Department of Neurosurgery, Hospital de Bellvitge, Barcelona, Spain.
FAU - Plans, Gerard
AU  - Plans G
AD  - Department of Neurosurgery, Hospital de Bellvitge, Barcelona, Spain.
FAU - Menchon, Jose Manuel
AU  - Menchon JM
AD  - OCD Clinical and Research Unit. Department of Psychiatry, Hospital de Bellvitge, 
      Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, 
      Spain; CIBERSAM (Centro de Investigacion en Red de Salud Mental), Carlos III 
      Health Institute, Madrid, Spain; Department of Clinical Sciences, Faculty of 
      Medicine, University of Barcelona, Spain.
FAU - Alonso, Pino
AU  - Alonso P
AD  - OCD Clinical and Research Unit. Department of Psychiatry, Hospital de Bellvitge, 
      Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, 
      Spain; CIBERSAM (Centro de Investigacion en Red de Salud Mental), Carlos III 
      Health Institute, Madrid, Spain; Department of Clinical Sciences, Faculty of 
      Medicine, University of Barcelona, Spain. Electronic address: 
      mpalonso@bellvitgehospital.cat.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220801
PL  - United States
TA  - Brain Stimul
JT  - Brain stimulation
JID - 101465726
SB  - IM
MH  - *Deep Brain Stimulation/adverse effects
MH  - Humans
MH  - Internal Capsule/physiology
MH  - Nucleus Accumbens
MH  - *Obsessive-Compulsive Disorder/diagnosis/therapy
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Comparative effectiveness
OT  - Deep brain stimulation
OT  - Long-term
OT  - Obsessive-compulsive disorder
OT  - Predictors of response
OT  - Side effects
COIS- Declaration of competing interest PA, ER, CS, MAA, GP and JMM participated in a 
      clinical trial sponsored by Medtronic to monitor the safety and performance of 
      electrical stimulation of the AIC in patients with chronic, severe, 
      treatment-resistant OCD from 2014 to 2017 (ClinicalTrial.gov identifier: 
      NCT01135745). The authors report no other biomedical financial interests or 
      potential conflicts of interest.
EDAT- 2022/08/05 06:00
MHDA- 2022/10/19 06:00
CRDT- 2022/08/04 19:26
PHST- 2022/04/15 00:00 [received]
PHST- 2022/07/09 00:00 [revised]
PHST- 2022/07/25 00:00 [accepted]
PHST- 2022/08/05 06:00 [pubmed]
PHST- 2022/10/19 06:00 [medline]
PHST- 2022/08/04 19:26 [entrez]
AID - S1935-861X(22)00170-X [pii]
AID - 10.1016/j.brs.2022.07.050 [doi]
PST - ppublish
SO  - Brain Stimul. 2022 Sep-Oct;15(5):1128-1138. doi: 10.1016/j.brs.2022.07.050. Epub 
      2022 Aug 1.