Deep brain stimulation (DBS) is an established and growing intervention for treatment-resistant obsessive-compulsive disorder (TROCD). We assessed current evidence on the efficacy of DBS in alleviating OCD and comorbid depressive symptoms including newly available evidence from recent trials and a deeper risk of bias analysis than previously available. PubMed and EMBASE databases were systematically queried using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We included studies reporting primary data on multiple patients who received DBS therapy with outcomes reported through the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Primary effect measures included Y-BOCS mean difference and per cent reduction as well as responder rate (≥35% Y-BOCS reduction) at last follow-up. Secondary effect measures included standardised depression scale reduction. Risk of bias assessments were performed on randomised controlled (RCTs) and non-randomised trials. Thirty-four studies from 2005 to 2021, 9 RCTs (n=97) and 25 non-RCTs (n=255), were included in systematic review and meta-analysis based on available outcome data. A random-effects model indicated a meta-analytical average 14.3 point or 47% reduction (p<0.01) in Y-BOCS scores without significant difference between RCTs and non-RCTs. At last follow-up, 66% of patients were full responders to DBS therapy. Sensitivity analyses indicated a low likelihood of small study effect bias in reported outcomes. Secondary analysis revealed a 1 standardised effect size (Hedges’ g) reduction in depressive scale symptoms. Both RCTs and non-RCTs were determined to have a predominantly low risk of bias. A strong evidence base supports DBS for TROCD in relieving both OCD and comorbid depression symptoms in appropriately selected patients.
- electrical stimulation
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RG and RN contributed equally.
Contributors RG, RN and SAS conceived the manuscript. RG, RN and SH acquired the data. RG and RN analysed the data. RG and RN drafted the manuscript. RG, RN, AA, ES, WKG, BS and SAS critically revised the manuscript. RG and SAS approved the final version of the manuscript.
Funding This work was supported by the McNair Foundation (SAS and WKG) and the Dana Foundation (SAS) (no award number available). ES reports support from the National Institute of Mental Health under award number 1RF1MH121371 and the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under award number P50HD103555 for use of the Clinical and Translational Core facilities.
Competing interests ES is a consultant for Biohaven and owns stock in NView. SAS is a consultant for Boston Scientific, Neuropace, Abbott and Zimmer Biomet. All other authors have no relevant disclosures.
Provenance and peer review Not commissioned; externally peer reviewed.
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