New Guidelines: Deep Brain Stimulation To Treat OCD

A team of experts have published a new clinical guideline that recommends deep brain stimulation for cases of obsessive-compulsive disorder (OCD) that do not respond to medication.

A group sponsored by the American Society of Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons performed a systematic review of research, analyzing the effectiveness of deep brain stimulation in treating OCD. The team reviewed more than 350 available papers, identifying 7 high-quality studies.
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In evaluating the evidence from these studies, the researchers concluded that bilateral stimulation, in which the subthalamic nucleus and the nucleus accumbens regions of the brains are stimulated, improved OCD symptoms by approximately 30 percent in clinical trials.

While the guideline states that bilateral stimulation is a “reasonable therapeutic option” for OCD patients who have not responded to other treatments, it also notes there is insufficient evidence supporting the use of unilateral stimulation—in which only one side of the brain is stimulated—for these patients.

Due to the limited number of participants in deep brain stimulation trials, the treatment is currently approved by the Food and Drug Administration under a “humanitarian device exemption,” with safeguards in place to ensure appropriate use, and deter overuse, of the procedure as a treatment option for OCD, according to the authors.

These safeguards are “valuable in preventing overuse of the therapy,” the authors wrote, noting that these additional steps may actually be impeding patients who could benefit from the therapy, “rather than achieving its proposed goal.”

Further, the authors noted that additional research is needed, and future studies must address outline areas, writing that “OCD comprises different clinical phenotypes. It is possible that particular patient subgroups may respond differently to deep brain stimulation, and that specific targets may be more suitable to treat a specific set of symptoms.”

—Mark McGraw

Reference

Hamani C, Pilitsis J, et al. Deep Brain Stimulation for Obsessive-Compulsive Disorder: Systematic Review and Evidence-Based Guideline Sponsored by the American Society for Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons (CNS) and Endorsed by the CNS and American Association of Neurological Surgeons. Neurosurgery. 2014.