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Review
. 2020 Jan;20(1):95-107.
doi: 10.1080/14737175.2020.1694409. Epub 2019 Nov 22.

Improving long term patient outcomes from deep brain stimulation for treatment-refractory obsessive-compulsive disorder

Andrew Guzick  1   2   3 , Patrick J Hunt  1   4 , Kelly R Bijanki  1 , Sophie C Schneider  1 , Sameer A Sheth  1 , Wayne K Goodman  1 , Eric A Storch  1
Affiliations
Review

Improving long term patient outcomes from deep brain stimulation for treatment-refractory obsessive-compulsive disorder

Andrew Guzick et al. Expert Rev Neurother. 2020 Jan.

Abstract

Introduction: Deep brain stimulation (DBS) has emerged as an effective treatment for patients with severe treatment-refractory obsessive-compulsive disorder (OCD). Over the past two decades, several clinical trials with multiple years of follow-up have shown that DBS offers long-term symptom relief for individuals with severe OCD, though a portion of patients do not achieve an adequate response.Areas covered: This review sought to summarize the literature on the efficacy and long-term effectiveness of DBS for OCD, and to identify strategies that have the potential to improve treatment outcomes.Expert opinion: Although this literature is just emerging, a small number of DBS enhancement strategies have shown promising initial results. More posterior targets along the striatal axis and at the bed nucleus of the stria terminalis appear to offer greater symptom relief than more anterior targets. Research is also beginning to demonstrate the feasibility of maximizing treatment outcomes with target selection based on neural activation patterns during symptom provocation and clinical presentation. Finally, integrating DBS with post-surgery exposure and response prevention therapy appears to be another promising approach. Definitive conclusions about these strategies are limited by a low number of studies with small sample sizes that will require multi-site replication.

Keywords: DBS; OCD; depression; internal capsule; neuromodulation; nucleus accumbens; stria terminalis; subthalamic nucleus; ventral capsule; ventral striatum.

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Conflict of interest statement

Declaration of interest

E Storch is a consultant for Levo Therapeutics. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.
Anatomical targets of deep brain stimulation for obsessive-compulsive disorder
See this image and copyright information in PMC

References

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    2. • This meta-analysis pooled outcome data from over 100 patients, the largest analysis of OCD DBS outcomes to date.

    1. Vázquez-Bourgon J, Martino J, Sierra Peña M, et al. Deep brain stimulation and treatment-resistant obsessive-compulsive disorder: A systematic review. Rev Psiquiatr Salud Ment Engl Ed. 2019;12 (1):37–51. - PubMed
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    2. •• This was the first report of DBS for OCD.

    1. Saxena S, Brody AL, Schwartz JM, et al. Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder. Br J Psychiatry. 1998;173(S35):26–37. - PubMed

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