Deep brain stimulation in the treatment of obsessive-compulsive disorder: current perspectives.
Research Domain Criteria
Yale-Brown obsessive-compulsive scale
cortico-striato-thalamo-cortical circuitry
deep brain stimulation
obsessive compulsive disorder
treatment-refractory
Journal
Neuropsychiatric disease and treatment
ISSN: 1176-6328
Titre abrégé: Neuropsychiatr Dis Treat
Pays: New Zealand
ID NLM: 101240304
Informations de publication
Date de publication:
2019
2019
Historique:
received:
22
01
2019
accepted:
23
04
2019
entrez:
14
6
2019
pubmed:
14
6
2019
medline:
14
6
2019
Statut:
epublish
Résumé
Deep brain stimulation (DBS) is a neuro-psychosurgical technique widely accepted in movement disorders, such as Parkinson's disease. Since 1999, DBS has been explored for severe, chronic and treatment-refractory psychiatric diseases. Our review focuses on DBS in obsessive-compulsive disorder (OCD), considered as a last treatment resort by most of learned societies in psychiatry. Two main stimulation areas have been studied: the striatal region and the subthalamic nucleus. But, most of the trials are open-labeled, and the rare controlled ones have failed to highlight the most efficient target. The recent perspectives are otherwise encouraging. Indeed, clinicians are currently considering other promising targets. A case series of 2 patients reported a decrease in OCD symptoms after DBS in the medial forebrain bundle and an open-label study is exploring bilateral habenula stimulation. New response criteria are also investigating such as quality of life, or subjective and lived-experience. Moreover, first papers about cost-effectiveness which is an important criterion in decision making, have been published. The effectiveness of tractography-assisted DBS or micro-assisted DBS is studying with the aim to improve targeting precision. In addition, a trial involving rechargeable pacemakers is undergoing because this mechanism could be efficient and have a positive impact on cost-effectiveness. A recent trial has discussed the possibility of using combined cognitive behavioral therapy (CBT) and DBS as an augmentation strategy. Finally, based on RDoc Research, the latest hypotheses about the understanding of cortico-striato-thalamo-cortical circuits could offer new directions including clinical predictors and biomarkers to perform adaptive closed-loop systems in the next future.
Identifiants
pubmed: 31190832
doi: 10.2147/NDT.S178207
pii: 178207
pmc: PMC6526924
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
1259-1272Déclaration de conflit d'intérêts
RR has received personal fees and non-financial support from Janssen Cilag, Esai, Medtronic, LivaNova. JR and GS received non-financial support from Medtronic and LivaNova. JR reports personal fees from Medtronic, personal fees and non-financial support from Elekta, and non-financial support from Boston Scientific, outside the submitted work. The authors report no other conflicts of interest in this work.
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