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Comparative effectiveness of neuroablation and deep brain stimulation for treatment-resistant obsessive-compulsive disorder: a meta-analytic study
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  • Published on:
    Study rigor may not impact finding of neuroablation superiority over deep brain stimulation for obsessive-compulsive disorder
    • Austin Y. Feng, Medical Student Stanford University
    • Other Contributors:
      • Uma V. Mahajan, Medical Student
      • Kevin K. Kumar, Neurosurgeon
      • Summer S. Han, Statistician
      • Casey H. Halpern, Neurosurgeon

    Introduction:

    Obsessive-compulsive disorder (OCD) is a neuropsychiatric disease characterized by distressing thoughts or urges that often require repetitive behaviors to suppress. OCD affects 2-3% of the general population and can have debilitating effects on normal functioning.[1] While most cases of OCD can be addressed through psychotherapy and/or medication, about 10% remain refractory, requiring neurosurgical intervention, such as neuroablation (ABL) or deep brain stimulation (DBS). These options possess their own respective advantages and disadvantages. ABL lacks the hardware concerns of DBS (e.g. device failure, battery replacement, etc.) and may be incisionless (e.g. stereotactic radiosurgery). Alternatively, DBS is non-lesional, and stimulation parameters can be titrated. While both ABL and DBS appear to be effective for refractory OCD, there is no clear consensus on their relative superiority/non-inferiority.

    Our group previously sought to address this question by comparing the two treatments’ relative utility. [1] Using a random-effects, inverse-variance weighted meta-analysis of 56 studies, utility was calculated from Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores and adverse event (AE) incidence. In our analysis, no significant differences were found between stereotactic radiosurgery and radiofrequency ablation, so their studies were combined and all considered under ABL. Ultimately, ABL yielded a significantly greater utility compared to...

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    Conflict of Interest:
    None declared.