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Research paper
Comparative effectiveness of neuroablation and deep brain stimulation for treatment-resistant obsessive-compulsive disorder: a meta-analytic study
  1. Kevin K Kumar1,
  2. Geoffrey Appelboom1,
  3. Layton Lamsam1,
  4. Arthur L Caplan2,
  5. Nolan R Williams3,
  6. Mahendra T Bhati1,3,
  7. Sherman C Stein4,
  8. Casey H Halpern1
  1. 1Department of Neurosurgery, Stanford University, Stanford, California, USA
  2. 2Department of Population Health, Division of Medical Ethics, New York University, New York City, New York, USA
  3. 3Department of Psychiatry, Stanford University, Stanford, California, USA
  4. 4Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Casey H Halpern, Department of Neurosurgery, Stanford University, Stanford, CA 94305-5327, USA; chalpern{at}stanford.edu

Abstract

Background The safety and efficacy of neuroablation (ABL) and deep brain stimulation (DBS) for treatment refractory obsessive-compulsive disorder (OCD) has not been examined. This study sought to generate a definitive comparative effectiveness model of these therapies.

Methods A EMBASE/PubMed search of English-language, peer-reviewed articles reporting ABL and DBS for OCD was performed in January 2018. Change in quality of life (QOL) was quantified based on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the impact of complications on QOL was assessed. Mean response of Y-BOCS was determined using random-effects, inverse-variance weighted meta-analysis of observational data.

Findings Across 56 studies, totalling 681 cases (367 ABL; 314 DBS), ABL exhibited greater overall utility than DBS. Pooled ability to reduce Y-BOCS scores was 50.4% (±22.7%) for ABL and was 40.9% (±13.7%) for DBS. Meta-regression revealed no significant change in per cent improvement in Y-BOCS scores over the length of follow-up for either ABL or DBS. Adverse events occurred in 43.6% (±4.2%) of ABL cases and 64.6% (±4.1%) of DBS cases (p<0.001). Complications reduced ABL utility by 72.6% (±4.0%) and DBS utility by 71.7% (±4.3%). ABL utility (0.189±0.03) was superior to DBS (0.167±0.04) (p<0.001).

Interpretation Overall, ABL utility was greater than DBS, with ABL showing a greater per cent improvement in Y-BOCS than DBS. These findings help guide success thresholds in future clinical trials for treatment refractory OCD.

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Footnotes

  • Contributors KKK, GA, SCS and CHH had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. KKK, GA, MTB, NRW, SCS and CHH were responsible for study concept and design. KKK, GA, LLBS, MTB, NRW, SCS and CHH were responsible for the acquisition, analysis and interpretation of data. KKK, GA, MTB, NRW, SCS and CH drafted the manuscript. KKK, GA, ALC, MTB, NRW, SCS and CHH critically revised the manuscript for important intellectual content. KKK, GA, SCS and CHH were responsible for the statistical analysis. CHH obtained the funding and was responsible for study supervision. CHH, SCS and KKK had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This study was supported by funds from the John A. Blume Foundation, the William Randolph Hearst Foundation and start-up funds from Stanford University’s Department of Neurosurgery.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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