PT  - JOURNAL ARTICLE
AU  - Kevin K Kumar
AU  - Geoffrey Appelboom
AU  - Layton Lamsam
AU  - Arthur L Caplan
AU  - Nolan R Williams
AU  - Mahendra T Bhati
AU  - Sherman C Stein
AU  - Casey H Halpern
TI  - Comparative effectiveness of neuroablation and deep brain stimulation for treatment-resistant obsessive-compulsive disorder: a meta-analytic study
AID  - 10.1136/jnnp-2018-319318
DP  - 2019 Apr 01
TA  - Journal of Neurology, Neurosurgery & Psychiatry
PG  - 469--473
VI  - 90
IP  - 4
4099  - http://jnnp.bmj.com/content/90/4/469.short
4100  - http://jnnp.bmj.com/content/90/4/469.full
SO  - J Neurol Neurosurg Psychiatry2019 Apr 01; 90
AB  - 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.