Deep Brain Stimulation for obsessive-compulsive disorder – a systematic review and meta-analysis.

Kisely, S., Hall, K., Siskind, D., Frater, J., Olson, S. and Crompton, D. (2014) Deep Brain Stimulation for obsessive-compulsive disorder – a systematic review and meta-analysis.. Psychological Medicine, 44 16: 3533-3542. doi:10.1017/S0033291714000981


Author Kisely, S.
Hall, K.
Siskind, D.
Frater, J.
Olson, S.
Crompton, D.
Title Deep Brain Stimulation for obsessive-compulsive disorder – a systematic review and meta-analysis.
Journal name Psychological Medicine   Check publisher's open access policy
ISSN 0033-2917
1469-8978
Publication date 2014-04-25
Year available 2014
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1017/S0033291714000981
Open Access Status Not yet assessed
Volume 44
Issue 16
Start page 3533
End page 3542
Total pages 10
Place of publication Cambridge, United Kingdom
Publisher Cambridge University Press
Language eng
Subject 3202 Applied Psychology
2738 Psychiatry and Mental health
Abstract Background. Deep brain stimulation (DBS) is increasingly being applied to psychiatric conditions such as obsessive-compulsive disorder (OCD), major depression and anorexia nervosa. Double-blind, randomized controlled trials (RCTs) of active versus sham treatment have been limited to small numbers. We therefore undertook a systematic review and meta-analysis of the effectiveness of DBS in psychiatric conditions to maximize study power.
Formatted abstract
Background: Deep brain stimulation (DBS) is increasingly being applied to psychiatric conditions such as obsessive-compulsive disorder (OCD), major depression and anorexia nervosa. Double-blind, randomized controlled trials (RCTs) of active versus sham treatment have been limited to small numbers. We therefore undertook a systematic review and meta-analysis of the effectiveness of DBS in psychiatric conditions to maximize study power. Method: We conducted a systematic literature search for double-blind, RCTs of active versus sham treatment using Pubmed/Medline and EMBASE up to April 2013. Where possible, we combined results from studies in a meta-analysis. We assessed differences in final values between the active and sham treatments for parallel-group studies and compared changes from baseline score for cross-over designs.

Results: Inclusion criteria were met by five studies, all of which were of OCD. Forty-four subjects provided data for the meta-analysis. The main outcome was a reduction in obsessive symptoms as measured by the Yale-Brown Obsessive Compulsive Scale (YBOCS). Patients on active, as opposed to sham, treatment had a significantly lower mean score [mean difference (MD) -8.93, 95% confidence interval (CI) -13.35 to -5.76, p < 0.001], representing partial remission. However, one-third of patients experienced significant adverse effects (n = 16). There were no differences between the two groups in terms of other outcomes.

Conclusions: DBS may show promise for treatment-resistant OCD but there are insufficient randomized controlled data for other psychiatric conditions. DBS remains an experimental treatment in adults for severe, medically refractory conditions until further data are available.
Keyword Deep brain stimulation
Meta analysis
Neurosurgery
Obsessive compulsive disorder
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2015 Collection
School of Medicine Publications
UQ Diamantina Institute Publications
 
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Created: Sat, 18 Oct 2014, 01:08:51 EST by Professor Steve Kisely on behalf of Psychiatry - Princess Alexandra Hospital