Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?

Hemmings Wu¹, Marwan Hariz², Veerle Visser-Vandewalle³, Ludvic Zrinzo⁴, Volker A Coenen⁵, Sameer A Sheth⁶, Chris Bervoets⁷, Matilda Naesström⁸, Patric Blomstedt⁹, Terry Coyne¹⁰, Clement Hamani¹¹, Konstantin Slavin¹², Joachim K Krauss¹³, Kai G Kahl¹⁴, Takaomi Taira¹⁵, Chencheng Zhang¹⁶, Bomin Sun¹⁶, Hiroki Toda¹⁷, Thomas Schlaepfer¹⁸, Jin Woo Chang¹⁹, Jean Régis²⁰, Rick Schuurman²¹, Michael Schulder²², Paresh Doshi²³, Philip Mosley²⁴, Anujan Poologaindran^{25

26}, Gabriel Lázaro-Muñoz²⁷, Joshua Pepper²⁸, Gaston Schechtmann²⁹, Anders Fytagoridis²⁹, Daniel Huys³⁰, Antonio Gonçalves-Ferreira³¹, Pierre-François D'Haese³², Joseph Neimat³³, Giovanni Broggi³⁴, Osvaldo Vilela-Filho³⁵, Jürgen Voges³⁶, Ahmed Alkhani³⁷, Takeshi Nakajima³⁸, Raphaelle Richieri³⁹, Diana Djurfeldt⁴⁰, Philippe Fontaine⁴¹, Roberto Martinez-Alvarez⁴², Yasushi Okamura⁴³, Jennifer Chandler⁴⁴, Katsushige Watanabe⁴⁵, Juan A Barcia⁴⁶, Blanca Reneses⁴⁷, Andres Lozano⁴⁸, Loes Gabriëls⁴⁹, Antonio De Salles^{50

51}, Casey H Halpern⁵², Keith Matthews⁵³, Joseph J Fins⁵⁴, Bart Nuttin⁵⁵

Affiliations

¹ Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
² Department of Clinical Neuroscience, Umeå University, Umeå, Sweden.
³ Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany.
⁴ Department of Clinical & Motor Neurosciences, UCL Queen Square Institute of Neurology, 33 Queen Square, London, WC1N 3BG, UK.
⁵ Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg, Germany.
⁶ Department of Neurological Surgery, Baylor College of Medicine, Houston, TX, USA.
⁷ Adult Psychiatry, Obsessive Compulsive Disorders Unit, UPC, and Department of Neuroscience, KU Leuven, Leuven, Belgium.
⁸ Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden.
⁹ Unit for Deep Brain Stimulation, Umeå University, Umeå, Sweden.
¹⁰ Queensland Brain Institute, University of Queensland, Brisbane, Australia.
¹¹ Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
¹² Department of Neurosurgery, University of Illinois, Chicago, IL, USA.
¹³ Department of Neurosurgery, Medical School Hannover, MHH, Hannover, Germany.
¹⁴ Department of Psychiatry, Social Psychiatry, and Psychotherapy, Medical School Hannover, MHH, Hannover, Germany.
¹⁵ Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
¹⁶ Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁷ Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Japan.
¹⁸ Department of Interventional Biological Psychiatry, Freiburg University Medical Center, Freiburg, Germany.
¹⁹ Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
²⁰ Aix Marseille University, Inserm UMR1106, Department of Functional and Stereotactic Neurosurgery, Public Assistance Marseille Hospitals, Marseille, France.
²¹ Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands.
²² Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
²³ Jaslok Hospital and Research Centre, Mumbai, India.
²⁴ Systems Neuroscience Laboratory, QIMR Berghofer Medical Research Institute, Australia and the Queensland Brain Institute, St Lucia, QLD, Australia.
²⁵ Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK.
²⁶ The Alan Turing Institute, British Library, London, UK.
²⁷ Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, 77030, USA.
²⁸ Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK.
²⁹ Department of Neurosurgery, Karolinska Institutet and University Hospital, Stockholm, Sweden.
³⁰ Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Cologne, Germany.
³¹ University Clinic of Neurosurgery, Faculdade Medicina Lisboa/Hospital Santa Maria, Lisbon, Portugal.
³² Vanderbilt School of Engineering, Nashville, TN, USA.
³³ University of Louisville, Louisville, KY, USA.
³⁴ Fond Istituto Neurologico C Besta, Milano, Italy.
³⁵ Stereotactic and Functional Neurosurgery Service, Department of Neurosurgery, Medical School, Clinics Hospital, Federal University of Goiás, Goiânia, Brazil.
³⁶ Department of Stereotactic Neurosurgery, Otto-von-Guericke University Magdeburg and Leibniz-Institute for Neurobiology, Magdeburg, Germany.
³⁷ Division of Neurosurgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
³⁸ Department of Neurosurgery, Jichi Medical University, Tochigi, Japan.
³⁹ Department of Psychiatry, Public Assistance Marseille Hospitals, Marseille, France.
⁴⁰ Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
⁴¹ Department of Psychiatry, CHC (Centre Hospitalier Chrétien), Liège, Belgium.
⁴² Unidad de Radiocirugía del Hospital Ruber Internacional de Madrid, Madrid, Spain.
⁴³ Department of Neurosurgery, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.
⁴⁴ University of Ottawa Centre for Health Law, Policy and Ethics, Ottawa, ON, Canada.
⁴⁵ Department of Neurosurgery, Tokyo Metropolitan Matsuzawa Hospital, Kamikitazawa, Setagaya, Tokyo, Japan.
⁴⁶ Department of Neurosurgery, Universidad Complutense de Madrid, Madrid, Spain.
⁴⁷ Institute of Psychiatry and Mental Health, Complutense University de Madrid, Madrid, Spain.
⁴⁸ Department of Neurosurgery, University of Toronto, Toronto, ON, Canada.
⁴⁹ Leo Schreursvest 13, 3001, Heverlee, Belgium.
⁵⁰ Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.
⁵¹ NeuroSapiens, Sao Paulo, Brazil.
⁵² Department of Neurosurgery, Stanford University Hospital, Stanford, CA, USA.
⁵³ Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, UK.
⁵⁴ Division of Medical Ethics, Weill Cornell Medical College and New York Presbyterian Weill Cornell Medical Center, New York, USA.
⁵⁵ Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium. Bart.Nuttin@uzleuven.be.

PMID: 33144712
PMCID: PMC7815503
DOI: 10.1038/s41380-020-00933-x

Review

Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?

Hemmings Wu et al. Mol Psychiatry. 2021 Jan.

. 2021 Jan;26(1):60-65.

doi: 10.1038/s41380-020-00933-x. Epub 2020 Nov 3.

Authors

Affiliations

¹ Department of Neurosurgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
² Department of Clinical Neuroscience, Umeå University, Umeå, Sweden.
³ Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany.
⁴ Department of Clinical & Motor Neurosciences, UCL Queen Square Institute of Neurology, 33 Queen Square, London, WC1N 3BG, UK.
⁵ Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg, Germany.
⁶ Department of Neurological Surgery, Baylor College of Medicine, Houston, TX, USA.
⁷ Adult Psychiatry, Obsessive Compulsive Disorders Unit, UPC, and Department of Neuroscience, KU Leuven, Leuven, Belgium.
⁸ Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden.
⁹ Unit for Deep Brain Stimulation, Umeå University, Umeå, Sweden.
¹⁰ Queensland Brain Institute, University of Queensland, Brisbane, Australia.
¹¹ Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
¹² Department of Neurosurgery, University of Illinois, Chicago, IL, USA.
¹³ Department of Neurosurgery, Medical School Hannover, MHH, Hannover, Germany.
¹⁴ Department of Psychiatry, Social Psychiatry, and Psychotherapy, Medical School Hannover, MHH, Hannover, Germany.
¹⁵ Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
¹⁶ Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
¹⁷ Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Japan.
¹⁸ Department of Interventional Biological Psychiatry, Freiburg University Medical Center, Freiburg, Germany.
¹⁹ Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
²⁰ Aix Marseille University, Inserm UMR1106, Department of Functional and Stereotactic Neurosurgery, Public Assistance Marseille Hospitals, Marseille, France.
²¹ Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands.
²² Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.
²³ Jaslok Hospital and Research Centre, Mumbai, India.
²⁴ Systems Neuroscience Laboratory, QIMR Berghofer Medical Research Institute, Australia and the Queensland Brain Institute, St Lucia, QLD, Australia.
²⁵ Brain Mapping Unit, Department of Psychiatry, University of Cambridge, Cambridge, UK.
²⁶ The Alan Turing Institute, British Library, London, UK.
²⁷ Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, 77030, USA.
²⁸ Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK.
²⁹ Department of Neurosurgery, Karolinska Institutet and University Hospital, Stockholm, Sweden.
³⁰ Department of Psychiatry and Psychotherapy, University Hospital of Cologne, Cologne, Germany.
³¹ University Clinic of Neurosurgery, Faculdade Medicina Lisboa/Hospital Santa Maria, Lisbon, Portugal.
³² Vanderbilt School of Engineering, Nashville, TN, USA.
³³ University of Louisville, Louisville, KY, USA.
³⁴ Fond Istituto Neurologico C Besta, Milano, Italy.
³⁵ Stereotactic and Functional Neurosurgery Service, Department of Neurosurgery, Medical School, Clinics Hospital, Federal University of Goiás, Goiânia, Brazil.
³⁶ Department of Stereotactic Neurosurgery, Otto-von-Guericke University Magdeburg and Leibniz-Institute for Neurobiology, Magdeburg, Germany.
³⁷ Division of Neurosurgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
³⁸ Department of Neurosurgery, Jichi Medical University, Tochigi, Japan.
³⁹ Department of Psychiatry, Public Assistance Marseille Hospitals, Marseille, France.
⁴⁰ Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
⁴¹ Department of Psychiatry, CHC (Centre Hospitalier Chrétien), Liège, Belgium.
⁴² Unidad de Radiocirugía del Hospital Ruber Internacional de Madrid, Madrid, Spain.
⁴³ Department of Neurosurgery, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.
⁴⁴ University of Ottawa Centre for Health Law, Policy and Ethics, Ottawa, ON, Canada.
⁴⁵ Department of Neurosurgery, Tokyo Metropolitan Matsuzawa Hospital, Kamikitazawa, Setagaya, Tokyo, Japan.
⁴⁶ Department of Neurosurgery, Universidad Complutense de Madrid, Madrid, Spain.
⁴⁷ Institute of Psychiatry and Mental Health, Complutense University de Madrid, Madrid, Spain.
⁴⁸ Department of Neurosurgery, University of Toronto, Toronto, ON, Canada.
⁴⁹ Leo Schreursvest 13, 3001, Heverlee, Belgium.
⁵⁰ Department of Neurosurgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA.
⁵¹ NeuroSapiens, Sao Paulo, Brazil.
⁵² Department of Neurosurgery, Stanford University Hospital, Stanford, CA, USA.
⁵³ Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland, UK.
⁵⁴ Division of Medical Ethics, Weill Cornell Medical College and New York Presbyterian Weill Cornell Medical Center, New York, USA.
⁵⁵ Department of Neurosurgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium. Bart.Nuttin@uzleuven.be.

PMID: 33144712
PMCID: PMC7815503
DOI: 10.1038/s41380-020-00933-x

Abstract

A consensus has yet to emerge whether deep brain stimulation (DBS) for treatment-refractory obsessive-compulsive disorder (OCD) can be considered an established therapy. In 2014, the World Society for Stereotactic and Functional Neurosurgery (WSSFN) published consensus guidelines stating that a therapy becomes established when "at least two blinded randomized controlled clinical trials from two different groups of researchers are published, both reporting an acceptable risk-benefit ratio, at least comparable with other existing therapies. The clinical trials should be on the same brain area for the same psychiatric indication." The authors have now compiled the available evidence to make a clear statement on whether DBS for OCD is established therapy. Two blinded randomized controlled trials have been published, one with level I evidence (Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score improved 37% during stimulation on), the other with level II evidence (25% improvement). A clinical cohort study (N = 70) showed 40% Y-BOCS score improvement during DBS, and a prospective international multi-center study 42% improvement (N = 30). The WSSFN states that electrical stimulation for otherwise treatment refractory OCD using a multipolar electrode implanted in the ventral anterior capsule region (including bed nucleus of stria terminalis and nucleus accumbens) remains investigational. It represents an emerging, but not yet established therapy. A multidisciplinary team involving psychiatrists and neurosurgeons is a prerequisite for such therapy, and the future of surgical treatment of psychiatric patients remains in the realm of the psychiatrist.

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Conflict of interest statement

MH has received travel expenses and honoraria from Boston Scientific for speaking at meetings. VV-V has received honoraria from Boston Scientific and Aleva for giving presentations and advice. LZ has acted as Consultant and received travel expenses and honoraria for educational activities from Medtronic, Boston Scientific and Elekta. VAC is a consultant for CORTICS, Munich and CorTec, Freiburg. He receives an ongoing grant from BrainLab, Munich; he has received honoraria and travel support for talks from Brainlab, Munich and Boston Scientific, USA. He receives support from Medtronic, USA and Boston Scientific, USA for IITs. SAS is consulting for Medtronic, Boston Scientific, NeuroPace, and Koh Young. MN received travel expenses by Medtronic for attending a DBS OCD-course. PB is a consultant for Abbott, Boston Scientific & Medtronic, and a shareholder in Mithridaticum AB. His research is supported by the Swedish Research Council. TC is involved in clinical trials of DBS for refractory OCD and anorexia nervosa, where the devices have been donated by Medtronic & Boston Scientific, respectively, but with the trials otherwise entirely independent of these companies, who have no rights to data or editorial input. KS is a consultant and received honoraria and/or research support from the following companies: Abbott, Medtronic, Boston Scientific, Nuvectra, Nevro, Neuros, ATI, Stimwave. JKK is a consultant to Medtronic and Boston Scientific. Chencheng Zhang has received honoraria and travel expenses from the Deep Brain Stimulation industry (Medtronic, PINS, SceneRay). BS received research support from PINS and SceneRay (donated devices). JR has acted as Consultant and received travel expenses and honoraria for educational activities from Medtronic, Boston Scientific and Elekta. RS is consultant to Boston Scientific, Elekta and Medtronic for educational activities. PM receives honorarium from Boston Scientific for speaking at an educational meeting and unrestricted educational grant from Medtronic. He is a principal investigator in trials of DBS for OCD and Anorexia Nervosa. GS receives research and travel grants from Medtronic and travel grants from Boston Scientific. AG-F is a member of the Medtronic Steering Committee for the MORE Registry study (ANT-DSBS for epilepsy). OV-F has received honoraria for educational activities from Medtronic and travel grants from the local representative of Abbott. LG was principal investigator of the OCD-PMCF trial, sponsored by Medtronic, and received consultancy fees from Medtronic. CHH has received speaking honoraria and consulting fees from Medtronic, Boston Scientific, and NeuroPace. KM has chaired advisory boards for studies of deep brain stimulation for OCD sponsored by Medtronic; has received unrestricted educational awards from Cyberonics Inc and Abbott (previously St Jude Medical), and has received travel and accommodation support to attend meetings from Medtronic and Abbott. BN is last author in Luyten et al. [6]. This work was supported by the Research Foundation—Flanders (FWO) Project G072909N, FWO Research Grant (to LL) 1504614N. All devices in the paper Luyten et al. [6], were generously provided by Medtronic. Medtronic also provided grants for research, education and traveling. He held the Medtronic Chair for Stereotactic Neurosurgery in Psychiatric Disorders at KU Leuven as well as a Chair for Neuromodulation, an endowment from Medtronic. BN co-owns a patent on DBS in OCD. The rest of the authors declare that there is no conflict of interest regarding the work described in this paper.

Comment in

Comment to: Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?
van Wingen G, Bergfeld I, de Koning P, Graat I, Luigjes J, Mocking R, Namavar Y, Ooms P, van Rooijen G, Vulink N, Mantione M, Figee M, Denys D. van Wingen G, et al. Mol Psychiatry. 2022 Mar;27(3):1276-1277. doi: 10.1038/s41380-021-01411-8. Epub 2022 Jan 7. Mol Psychiatry. 2022. PMID: 34992236 No abstract available.

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Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?

Affiliations

Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

References

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MeSH terms

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