Deep brain stimulation effective in the treatment of refractory OCD

Deep brain stimulation (DBS) is a very promising alternative for patients with obsessive-compulsive disorder (OCD) that is refractory to other treatment. An open study provided strong evidence for the effectiveness and safety of DBS for treatment of refractory OCD. Clinical and demographic factors cannot yet predict outcomes and should not be used to exclude patients from this treatment  [1,2].

OCD is the 10^th leading cause of disability of all medical conditions in the industrialised world, with a prevalence of about 2% in the general population. Conventional treatments, mainly cognitive behavioural therapy and medication, are effective in about 90% of patients. Unfortunately, approximately 10% of patients do not respond to these treatments. Small clinical trials have shown that DBS can be effective in refractory OCD patients, but clinical experience is still limited.

In a Dutch, single-centre study performed at the Amsterdam University Medical Center, a cohort of 70 refractory OCD patients underwent DBS of the ventral anterior limb of the internal capsule. Inclusion criteria were severe OCD (defined as Yale-Brown obsessive-compulsive scale [Y-BOCS] ≥28) with insufficient response to 2 selective serotonin reuptake inhibitors (SSRIs) and additional antipsychotics, clomipramine, and cognitive behavioural therapy. Patients with a psychotic disorder or unstable neurological disease were excluded. At fixed time points, symptoms of OCD, anxiety, and depression, as well as adverse effects were assessed; follow-up was 12 months.

After 12 months, mean Y-BOCS score had decreased by 13.5 (40% reduction). Symptoms of anxiety and depression decreased by around 55%. Response was seen in 36 patients overall (52%), partial response in 12 (17%), and no response in 22 (31%). DBS was generally well tolerated. Adverse effects included transient symptoms of hypomania (39%), headache (36%), and hardware-related symptoms.

Individual response was predicted by insights into the illness, with a positive predictive value of 84.4% and negative predictive value of 44%. Non-response was predicted by early-onset OCD and by comorbid personality disorder. However, they could not significantly predict outcome and can therefore not (yet) be applied to optimise patient selection.

1. 
   
   1. Graat I. Deep brain stimulation improves treatment-refractory obsessive compulsive disorder; results of a cohort including 70 patients. S.10.05, ECNP 2021 Congress, 2–5 October.
   2. Denys D, et al. Am J Psychiatry. 2020;177(3):265–271.

 

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Posted on 26 November 2021