Deep brain stimulation for treatment-refractory obsessive compulsive disorder: a systematic review

BMC Psychiatry

Jens Kuhn⁵  Veerle Visser-Vandewalle²  Doris Lenartz²  Ulf J Mueller⁴  Damiaan Denys³  Judy Luigjes¹  Deva M Schönherr⁵  Sina Kohl⁵ 

[1] Department of Psychiatry, Academic Medical Center, Meibergdreef 5, Amsterdam, 1105 AZ, the Netherlands;Department of Stereotactic and Functional Neurosurgery, University of Cologne, Kerpener Strasse 62, Cologne, 50937, Germany;The Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, Meibergdreef 47, Amsterdam, 1105 BA, the Netherlands;Department of Psychiatry and Psychotherapy, University of Magdeburg, Leipzigerstrasse 44, Magdeburg, 39120, Germany;Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, Cologne, 50937, Germany

关键词: Psychiatric surgery;    Treatment-refractory;    Obsessive compulsive disorder;    Deep brain stimulation;   

Others  :  1123430
DOI  :  10.1186/s12888-014-0214-y

 received in 2014-03-24, accepted in 2014-07-18,  发布年份 2014

【 摘 要 】

Background

Obsessive-compulsive disorder is one of the most disabling of all psychiatric illnesses. Despite available pharmacological and psychotherapeutic treatments about 10% of patients remain severely affected and are considered treatment-refractory. For some of these patients deep brain stimulation offers an appropriate treatment method. The scope of this article is to review the published data and to compare different target structures and their effectiveness.

Methods

PubMed search, last update June 2013, was conducted using the terms “deep brain stimulation” and “obsessive compulsive disorder”.

Results

In total 25 studies were found that reported five deep brain stimulation target structures to treat obsessive-compulsive disorder: the anterior limb of the internal capsule (five studies including 14 patients), nucleus accumbens (eight studies including 37 patients), ventral capsule/ventral striatum (four studies including 29 patients), subthalamic nucleus (five studies including 23 patients) and inferior thalamic peduncle (two studies including 6 patients). Despite the anatomical diversity, deep brain stimulation treatment results in similar response rates for the first four target structures. Inferior thalamic peduncle deep brain stimulation results in higher response rates but these results have to be interpreted with caution due to a very small number of cases. Procedure and device related adverse events are relatively low, as well as stimulation or therapy related side effects. Most stimulation related side effects are transient and decline after stimulation parameters have been changed.

Conclusion

Deep brain stimulation in treatment-refractory obsessive-compulsive disorder seems to be a relatively safe and promising treatment option. However, based on these studies no superior target structure could be identified. More research is needed to better understand mechanisms of action and response predictors that may help to develop a more personalized approach for these severely affected obsessive compulsive patients.

【 授权许可】

   
2014 Kohl et al., licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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